How employers can help employees deal with substance misuse — without stigma

Addiction is a brain disorder, a physical disease that changes the way brain chemistry works, not a moral failing. And while miscommunication had led to significant stigma, society — including employers — must change the way it looks at, and reacts to, it, says Caesar DeLeo, M.D., MHSA, vice president and executive medical director, Strategic Initiatives, at Highmark Blue Cross Blue Shield.

“Addiction, or substance use disorder, is a chronic disease, similar to high blood pressure or diabetes,” says DeLeo. “Employees who struggle with chronic disease don’t choose to underperform. We don’t have a cure, but the response rates to treatment for substance use disorder abuse are similar to those of other chronic illnesses.”

Smart Business spoke with DeLeo about how employers can help employees deal with addiction and how prevention, mitigation and treatment can help lessen the impact of the disease on your employees, their families and your business.

How can prevention, mitigation and treatment mitigate risk?

Most people don’t get screened, and 90 percent of those living with substance misuse never receive treatment. Screening is critical to identify those at higher risk to prevent them from moving up that next continuum of the disease. This includes reaching young people in schools and offering programs to increase awareness and delay the onset of substance use and potential abuse.

With mitigation, clinicians help people at risk learn techniques to reduce consumption. Along with that, medications need to be prescribed in a responsible manner.

Treatment is for those with more serious disease, and removing barriers to access, especially stigma, financial barriers to getting medication, therapy and telemedicine services, is critical. Too often, people fail to seek treatment, especially for the misuse of alcohol. This leading cause of death among substance users is treatable, and employers should make resources available so employees can seek the help they need, without attaching stigma.

What role does telemedicine play in treatment?

Providing teleaddiction counseling as part of an employer’s health care benefits package can be as effective as in-person care, and many patients prefer this option. People do not tend to initiate care unless absolutely necessary, but are more likely to do so when a telehealth option is available.

Telemedicine also removes barriers to treatment. People fear judgment, are busy, there can be transportation or childcare issues, work schedules can be a barrier to access. A working person could do a call on a break. And while those at home may not be able to leave for an appointment, they can go to a private room for a call.

The pandemic removed people with substance use disorder issues from regular communication and support systems, and without someone there to help, they can relapse. Telemedicine can help restore those connections and that support system.

Why should employers be concerned about substance use, and what is their role?

Substance use disorder results in losses of $600 billion a year in lost productivity, increased health care costs and increased crime rates, impacting employees, their families and employers. For every dollar spent on treatment, $12 in health care costs are saved, making for a very positive return on investment for employers.

Employers have been unsure how to approach this issue. and have used punitive policies. We are working to inform them about creating alternate policies so that individuals are capable of work and can come back after treatment.

Recovery-friendly companies allow employees to discuss the disease without being penalized, creating a workplace where people can share their experiences with others who are struggling.It’s reassuring to employees to know that their employer is sensitive to real-life issues that impact them, making them more attentive and allowing you to develop a loyal and productive workforce.

The pandemic has created additional stresses for employees, and with remote work, employers may not be aware of their struggles. Providing access to an employee assistance program gives people a place to be screened and guides them to information and confidential treatment.

INSIGHTS Health Care is brought to you by Highmark Blue Cross Blue Shield.

Addressing social determinants of health can improve lives, lower costs

Employees are struggling. Half of U.S. households had difficulty paying expenses in the previous month, according to a March survey by the U.S. Census Bureau. A quarter reported delaying medical care. And one-third reported symptoms of depression.

As an employer, those numbers should concern you, says Nebeyou Abebe, senior vice president of Social Determinants of Health (SDOH) for Highmark Blue Cross Blue Shield.

“Social determinants not only impact your employees’ personal lives but also their job performance,” says Abebe. “Employees worried about feeding their children or paying for medical care are likely not operating at maximum capacity. Looking at the health of a population and the social factors that drive health allows you to address social barriers to health and well-being, improve health outcomes and lower costs.”

Smart Business spoke with Abebe about how to address SDOH to improve quality of life, increase engagement and productivity, and control costs.

How can addressing SDOH help improve outcomes and decrease costs?

While companies may think offering benefits is enough, many take a passive approach to promoting them. So while they are available, oftentimes employees are either not aware of them or not utilizing them. As a result, organizations have a tremendous opportunity to take a more employee-centric approach to identify the root factors that impact health.

Clinical factors account for only 20 percent of health care needs, while behaviors, physical environment and socioeconomic factors — where people live, their social support, access to health care, education and healthy food, financial distress, etc. — account for 80 percent. So you can’t just look at clinical factors; you have to look at life factors, as well.

How can a change in benefits strategy impact employee health?

Over the past several years, more organizations are rethinking their benefits strategies to address the needs of all employees, especially the social barriers that affect health and well-being. Employers need to understand what employees are struggling with and use that to inform strategy and shift their investment. By addressing factors that impact physical well-being, you can increase engagement and productivity, improve health outcomes and lower health care costs.

In the past, employers have focused on equality, with every employee having access to the same benefits for the same cost. To better meet employees’ needs, design a program with an equity perspective, in which all have access and benefits are affordable to all, with tiered premiums. Also, an employer can offer childcare subsidies or homebuying workshops, provide healthier alternatives in vending machines, subsidize public transportation or offer housing to employees at below-market rates.

How can an SDOH approach improve an organization?

An SDOH approach allows you to control costs and improve employees’ health by addressing the 80 percent of factors that impact health and well-being. It’s a wise investment and a way to help achieve your objectives and the return on investment in health and well-being programs. Look at the health of your population and the social factors that drive health to create a strategy to address social barriers to achieving it.

Your health benefits provider should be able to help leverage your data and identify vulnerability factors to gain a fuller picture of your population and meet employees where they are to help them access appropriate services and enhance their experience of health care to improve outcomes.

Health care costs are a national crisis, and the only way to control costs is to address these underlying factors. Employers are spending more each year on premiums and need to bend the cost curve by focusing on SDOH. It’s the right thing to do in terms of making a strategic investment in the health of employees and the broader community.

By engaging employees in good decision-making and changing the design of your benefits and your approach to employee well-being programs, you can help employees thrive and live better lives, enhancing productivity and lowering costs.

Insights Health Care is brought to you by Highmark Blue Cross Blue Shield

Use is on the rise, and at-home health care is here to stay

While telehealth has been available for some time, the pandemic has exponentially increased its use. And the use of telehealth will continue post-pandemic as people embrace the convenience of obtaining care from home.

“Telehealth has been incredibly useful in terms of providing access to needed care during the pandemic,” says David S. Webster, M.D., MBA, Vice President and Executive Medical Director, Clinical Services, Highmark Blue Cross Blue Shield. “Usage may differ as we leave the pandemic, and we will still see a significant number of in-person visits, but there is a wider acceptance of telehealth. And in the future, telehealth care will simply be considered health care as more care is moved to the home.”

Smart Business spoke with Webster about the increased usage of telehealth services and the future of the industry.

How has the pandemic sped up the move toward telehealth?

At the beginning of the pandemic, telehealth was a niche service. Then in March 2020, with the advent of stay-at-home orders, access to health care at medical clinics became nearly nonexistent. Almost overnight, telehealth went from nearly zero percent usage to being the way the majority of care was accessed — telehealth visits for our members increased 3,400 percent in 2020. With as quickly as it happened, many expected it would be a challenge, but it went much more smoothly than expected.

What kinds of conditions can be diagnosed and treated via telehealth — and which can’t?

One big area is behavioral health. A physical exam is rarely necessary as part of behavioral health treatment, so telehealth is a good fit. For some patients, there is a perceived stigma in going into a doctor’s office to receive behavioral health care. Telehealth allows someone to connect one on one with a doctor in a more private setting, from their home.

Telehealth can also be used as a screening tool, with a physician asking simple yes or no questions to determine if the person can be safely treated with telehealth or if they need a different care setting. There are a significant number of important diagnostic cues that can be derived through audio and video, simply by observing and asking questions.

In addition, many things that would be treated in an urgent care setting can be diagnosed via telehealth. Telehealth can also be used for the management of chronic diseases, when someone needs to be followed closely to ensure a disease doesn’t progress. That monitoring doesn’t necessarily require in-person care and can oftentimes be conducted remotely.

What are the benefits of telehealth?

The No. 1 attraction for patients is convenience. With a typical visit to a doctor’s office, you have to get in your car, drive to that location, check in, sit in the waiting room, get moved to the exam room, have the exam, check out and drive home. With telehealth, patients are notified when the doctor is ready to see them and they proceed directly to the appointment without leaving home.

In rural areas, there may be broadband challenges to resolve for optimum effectiveness of telehealth appointments. But conversely, if you live in a rural area, you may have to drive long distances for medical care.

With telehealth, you can now access some care directly from your home. And age doesn’t seem to be a deterrent; in 2020, nearly half of our members over the age of 60 participated in a telehealth appointment.

The key in health care is to simplify care, make it proactive and personalize it. We expect to see a continued uptake in telehealth usage and acceptance as part of a broader transition to receiving care at home. Telehealth will be part of creating an excellent experience for the consumer.

Insights Health Care is brought to you by Highmark Blue Cross Blue Shield

How fighting fraud, waste and abuse in health care benefits everyone

Fraud, waste and abuse in the health care system are rampant, with 4 to 7 percent of health care expenses attributed to these actions.

“The vast majority are errors, waste and abuse such as improperly coding a medical claim submitted to an insurer, while a small minority is fraud committed with the intent to receive improper payment,” says Kurt Spear, vice president of Financial Investigation and Provider Review at Highmark Blue Cross Blue Shield. “This is costly to the entire system and to consumers, and everyone needs to work together to reduce unnecessary costs.”

Smart Business spoke with Spear about how health plan payers, medical providers, employers and consumers can help reduce fraud, waste and abuse in health care.

What are some examples of waste, fraud and abuse?

Examples include providing unnecessary services, such as X-raying every patient, not following medical best practices and not using resources wisely. Excessive charges can also result from mistakes in coding or taking advantage of the system in the form of upcoding or unbundling of services.

Although waste and abuse are more prevalent, fraud does exist across the health care landscape. Fraud occurs when bad actors have intent to knowingly obtain improper payment or something of value. As fraudsters become more sophisticated, it is critical for health payers to innovate and cooperate with organizations nationally to identify and root out issues before they become full-blown fraud schemes.

How is technology helping to identify patterns of misuse?

Technology is critical. Historically, health plans have looked for patterns of unusual activity in data, such as providers billing for unusual services outside of their practice areas, or members receiving services that don’t make sense from a medical treatment standpoint. When an aberrancy was identified, health plans investigated.

With the help of technology, including artificial intelligence, health plans no longer need to wait to identify suspect activity in the data. This allows fraud schemes to be mitigated faster, with less financial impact.

Although technology is vital to identifying potential fraud, waste and abuse, it takes a team of trained professionals to investigate and resolve these schemes. Health plans commonly work with a wide range of professionals, including former law enforcement, physicians, hospital revenue cycle administrators, coders, pharmacists and nurses who can identify where there might be unnecessary procedures or medications, or billing and coding anomalies.

How can a health plan help self-funded companies monitor for errant billing?

Coordination is key. It takes all of us working together, health plans, employer groups and members, to have an impact. Self-funded customers continue to develop advanced tools to report on treatment and medical claims patterns. Health plans often work with customers to communicate unusual trends and look out for fraud.

Health plans can also conduct educational activities with customers to aid in understanding the red flags of fraud, waste and abuse. Sometimes the best tips come from our customers. If a member sees something unusual on their explanation of benefits — services billed that they didn’t receive, for example — they should call the anti-fraud unit listed on the EOB.

Members should also be aware of schemes that include unusual phone calls regarding their benefits, or someone reaching out on social media. These contacts can seem legitimate, but if someone asks for your Social Security number or health insurance ID number, or makes an offer that seems too good to be true in terms of rewards, gift cards or free vacations, question that. If you have suspicions, reach out to your health plan.

Ultimately, health care fraud, waste and abuse drive up the cost of health care for everyone, raising the cost of premiums, out-of-pocket expenses, deductibles and co-pays. It impacts all of us, both individually and as taxpayers, as fraud, waste and abuse in federal programs such as Medicare and Medicaid increase costs across the board.

Learning to identify unusual activity on billing statements and ads on social media, for example, are good ways to help drive better outcomes for members and patients and lower costs for all.

INSIGHTS Health Care is brought to you by Highmark Blue Cross Blue Shield.

Develop these habits to improve your health at work

The average American spends more than 40 hours each week on the job. This adds up to about a third of our lives. With so much time spent in one place, it’s important to ensure we make the most of that time and do what we can to stay healthy.

Managing stress and practicing healthy habits can seem like a lot to handle on top of a busy schedule. But, as Amanda Budzowski, director of Clinical Training and QA at UPMC Health Plan, notes, you can make healthy changes manageable by starting small and adding a few things at a time.

Smart Business spoke with Budzowski about her tips and tricks to improve your health while at work.

What are some important eating habits?

  • Eat a good breakfast — Most Americans admit skipping this important meal, citing a lack of time. But eating breakfast will help you feel fuller longer, prevent unhealthy snacking and improve your concentration and mental sharpness.
  • Build a healthy lunch routine — One of the common barriers to eating healthy (and managing weight) is the lunchtime rut. We’ve all been there: You rush out the door, forget your lunch and have to eat takeout. Typically, those meals are not the healthiest. With a little bit of planning and creativity, you can enjoy a healthy lunch every day.
  • Change your snacking habits — It’s important to pack small meals that you can eat when you’re moving from meeting to meeting. If you don’t, you may make unhealthy food choices if you allow yourself to become too hungry. Develop a habit of keeping healthy snacks in your lunch bag or desk. Easy go-to options include hard-boiled eggs, rice cakes, almonds and protein bars.
  • Stay hydrated — This healthy habit plays an important part in both fitness and weight loss. Your body uses water to maintain your temperature, lubricate your joints, remove waste and much more. For most people, water is the best option to stay hydrated, but foods like fruits and vegetables also have a high percentage of water.
  • Practice good hygiene — Many of us eat lunch (and sometime breakfast) at our desks. This habit can make you sick. There are bacteria lurking on our desktops. Make sure you protect yourself from food-borne illness by cleaning your area before and after you eat, properly storing hot and cold foods, and eating office snacks when they are their freshest.

How else can you improve your health?

  • Prepare for the stress you can’t avoid — Unmanaged stress in the workplace can take a toll on your performance. It’s important to identify your triggers and have a coping technique planned.
  • Reduce your sitting time — Many of us have long commutes and even longer periods of sitting once we’re at work. Find ways to cut your sedentary time and add minutes of activity to your day. Doing so can lower your risk for health problems, including back pain.
  • Wash your hands — Handwashing is one of the easiest ways to protect yourself from getting sick or spreading germs to others, yet many people don’t do it often enough. Always remember to wash before eating, after encountering someone who’s sick and after using the restroom.
  • Avoid digital eye strain — The average office worker spends six to nine hours each workday on a computer or staring at a screen. To give your eyes a break, follow the 20-20-20 rule: Every 20 minutes, take a break to stare at something 20 feet away for 20 seconds.
  • Make time for physical activity — Use part of your lunch break to walk, schedule walking meetings, park farther away and take the stairs as much as possible. All are simple ways to incorporate more activity into your day.
  • Get enough sleep — Not getting enough sleep can affect all areas of your health and wellness. In addition, it can impact your productivity at work. Getting seven to eight hours sleep (or the amount that works best for your body) will help you begin each workday feeling energized and refreshed.

Staying healthy at work doesn’t have to be a chore. The best advice is to start slowly and add healthy habits as you can. In time, you will find that you feel better, are more productive and are a lot less stressed. What tip will you try today?

Insights Health Care is brought to you by UPMC Health Plan

Energizing employees about their health benefits

Surveys show that health benefits selection is confusing and stressful for employees. Getting your employees more involved in open enrollment and other benefits administration activities can pay big dividends in reducing this negative experience, says Jo Hartoyo, CTO at eBenefits Solutions, an affiliate company of the UPMC Insurance Services Division. This division includes UPMC Health Plan, UPMC WorkPartners, LifeSolutions, UPMC for Life, UPMC for You, UPMC for Kids and Community Care Behavioral Health.

Smart Business spoke with Hartoyo about ways to engage employees through their benefits selections.

What are the benefits of increased employee engagement?

According to a recent survey, when employees are actively engaged in choosing their benefit options, they are three times more likely to be satisfied with their jobs than employees who are not actively engaged.

Those who are actively engaged in choosing their benefits are twice as likely to value those benefits their employer is offering.

The key takeaway is that a more engaged employee is going to make better-informed benefit choices. This helps both the employee and the employer. The employee can potentially save thousands of dollars by choosing the right plan and the employer is more likely to save on overall health care costs.

How can employers encourage more engagement?

  1. Offer integrated tools. It’s best to integrate decision-making tools, cost calculators and other helpful information directly into the benefits enrollment process. These tools enhance the benefits enrollment experience and provide a more interactive, engaging experience. This makes it easier for employees to evaluate options and to make the right decisions. This enhanced level of self-service has the beneficial side effect of freeing up your HR business partners so they can tend to higher-level strategic programs aimed at achieving the organization’s goals.
  2. Provide user-friendly, web-based technology. Better-designed technology with simpler, more intuitive interfaces is vital for increasing employee engagement. Employees are consumers and, as such, expect retail-like websites that are easy to use. It’s also vital to allow employees the ability to enroll in and manage all of their benefits seamlessly through a secure single-sign-on technology platform.
    In addition, single-page applications allow employees to access their benefits, claims information and human resource updates all on the same screen, as opposed to skipping around from screen to screen where each page has a different look and feel. The one-screen approach makes navigation far simpler, more intuitive and more responsive for a better overall user experience.
  3. Communicate with a multi-channeled approach. A workplace survey found that when employees received benefits communications through their preferred channels — via print, email, onsite meetings or a combination — 70 percent were very confident in their selections. When employees didn’t receive benefits communications through their preferred channels, less than 40 percent were very confident in their selections. Overall, the study showed that when employees both receive communications and enroll through their preferred channels, they are more likely to make better enrollment decisions. They are more informed about health benefit details such as deductibles, out of pocket maximums, and employer contributions.

At the end of the day, in order to energize and engage your employees with their benefits, you want to make things easy for them.

A basic example of this is to allow employees to enroll online. This means employees can sign up 24/7 from their home or office and can check their selections and benefits any time. It’s also much easier for employees to compare plan options and benefit details when everything is online.

These simple strategies will yield a huge payoff in terms of getting employees more engaged in the process and happier with their benefit selections. This translates to more satisfied employees and higher employee retention.

Insights Health Care is brought to you by UPMC Health Plan

How to integrate leave of absence and employee assistance programs

A 2013 study by the Integrated Benefits Institute (IBI) reported that the prevalence of depression among workers is close to 20 percent and that more than 60 percent of these depressed employees go untreated. At the same time, 97 percent of employees who file a leave claim for depression also report other comorbid conditions.

The impact of depression and other conditions may be amplified when employees are on leave caring for family members who need them. At a minimum, there are emotional, financial and lifestyle implications for these employees.

For employers, the IBI study estimated the yearly cost in lost work time and medical treatments at $62,000 per 100 employees. In an internal analysis of its parent company, WorkPartners discovered that employees who took a leave of absence were 5 percent more likely to suffer depression than they were before taking the leave.

Smart Business spoke with Jim Kinville, senior director of LifeSolutions, and Linda Croushore, senior director of Disability Services at UPMC, about how employers can help employees who are fighting depression or other conditions while on leave.

How can employers ensure their employees on leave have the resources they need?

To combat these challenges and their associated costs, you’ll want to consider programs that can engage employees on leaves of absence with an employee assistance program (EAP) to help employees manage the range of life challenges they may be facing.

A pilot program included employees who called in to request a leave to care for a spouse, child and/or parent.

The leave intake specialists processed the leaves as normal and then, near the end of the interaction, transferred the employee to a live phone connection with the EAP provider. Next, the EAP care manager engaged the employee in a conversation, giving the employee information on services that may assist the employee based on the details of the individual situation. Each employee’s original EAP care manager then made a follow-up call 30 days later to review the employee’s needs and provide additional support if appropriate.

What types of services would this integrated approach include?

By speaking with the EAP care manager, employees are able to determine services that will best assist them throughout their leave. The types of services used by those who accept assistance will vary, but with the diverse concerns and issues these employees experience as they go through the leave process, the services most utilized tend to be referrals to the Institute on Aging, general counseling, child care, legal services and financial consultations.

Most individuals using leave need to manage multiple issues. EAP care managers report they helped to address nine or more different areas of need related to health, emotional issues, work-life balance, financial, legal and more. In fact, it is rare that someone only has one specific area of need. Care managers have assisted with linkages to other programs, such as wellness coaching and complex case management.

What are the effects of EAP programs on leave duration?

While the results of programs that consider a number of variables (type of leave, leave circumstances, etc.) are still being studied to fully determine the effect of EAP programs on leave duration, some key results from the pilot program included:

  • All employees who were transferred to the EAP accepted the initial services for a 100 percent engagement rate. An informational flier was sent to all callers who agreed to receive it.
  • Care managers reported there were no complaints about the offer of free services through the EAP.
  • Of the employees who were transferred to the EAP, 12 percent accepted services beyond the initial transfer.
  • Employees who used the extra support experienced leave durations that were, on average, four days shorter than those who did not use the support.

Insights Health Care is brought to you by UPMC Health Plan

Do you know the value of positive psychology?

The field of positive psychology has many resources to help us increase positivity in our daily lives.

“This field emerged because leading psychologists believed their discipline could offer help beyond understanding and treating psychological disorders,” says Dennis Daley, Ph.D., senior clinical director of Substance Use Services at UPMC Health Plan. “They began to examine how we can live happier, more fulfilling lives and achieve better health and a longer life.”

Smart Business spoke with Daley about how positivity can lead to a better life.

Can psychology foster positive emotions?

Most people want to feel good. They strive for positive emotions. Positive psychology analyzes these emotions: what they are, how they improve well-being and how to make them a bigger part of your life. They include compassion, happiness, love, gratitude and satisfaction. They are often based in relationships, achievements and a sense of purpose or meaning. Of course, none of this works if we simply ignore problems.

How does positive psychology help you cope with negative events and emotions?

Negativity surrounds us. Most news focuses on problems: bad events, bad behaviors of individuals. Sometimes painful or traumatic events happen in our lives: the death of a loved one, a failed relationship, job loss or another significant loss. We cannot avoid negative emotions or events — nor should we. But emotions can be used in positive ways to serve important functions:

Anger is negative when it:
— Leads to giving up too easily on a problem or task.
— Is expressed verbally or physically in an aggressive or violent manner.
— Is stifled and shows up in physical symptoms or passive-aggressive behaviors that harm a relationship.

But is positive when it:
— Motivates us to work hard to achieve a goal, complete a project or task, or face a difficult experience or person.

Anxiety/fear is negative when it:
— Becomes persistent and overwhelms us.
— Leads to physical and emotional distress or avoidant behavior.
— Is symptomatic of an anxiety disorder.

But is positive when it:
— Helps us stay vigilant to avoid or minimize threats.
— Motivates us to better prepare for a job interview, an important meeting or a presentation at work or school.

Grief is negative when it:
— Is too intense over a long time.
— Interferes with our ability to function or form new relationships through the grief process.

But is positive when it:
— Is a way of expressing our suffering as well as our love for a lost loved one.
— Leads others to show their love and support and help us.
— Deepens our commitment to other loved ones, or has positive effects on spiritual or religious beliefs or practices.

Guilt is negative when it:
— Leads to obsessive thoughts that make it difficult to focus on daily living.
— Makes us reluctant to enjoy life and more willing to punish ourselves.

But is positive when it:
— Influences us to correct problems in relationships or change our behavior that others find hurtful.

Positivity helps us keep our lives balanced so that negative emotions don’t drag us down too far. When we work at positivity, it becomes easier to know when that balance is upset and we need help dealing with our emotions. We often judge ourselves harshly, beating ourselves up over our faults, flaws and shortcomings. That makes us feel isolated, unhappy and even more stressed; it may even make us try to feel better about ourselves by denigrating other people.

Rather than harsh self-criticism, a healthier response is to treat yourself with compassion and understanding. According to psychologist Kristin Neff, this self-compassion has three main components: mindfulness, a feeling of common humanity and self-kindness. She suggests that you write a letter to yourself expressing compassion for an aspect of yourself that you don’t like. Research suggests that people who respond with compassion to their flaws and setbacks experience greater physical and mental health.

Insights Health Care is brought to you by UPMC Health Plan

Payer-provider integration is key to nationwide health care reform

Individuals and business have long sought changes to our health care system that would improve its quality and reduce the cost of care coverage.

“However, systematic solutions have been hard to find; health care in the U.S. is more costly than other developed nations without delivering better outcomes. We seek evidence of payment and delivery structures that deliver better care at lower costs,” says Dr. William H. Shrank, chief medical officer at UPMC Health Plan.

Studies have shown that greater provider consolidation leads to increased costs. Yet, consolidation, when coupled with integration of a payer and provider, seems to deliver different results.

Smart Business spoke with Shrank about an integrated delivery and finance system (IDFS) that was pioneered in Pittsburgh, which could serve as a national model for better care at lower costs.

How did the IDFS model emerge in Western Pennsylvania?

UPMC took the first step in establishing an IDFS when it launched its health plan in 1996. At the time, Pittsburgh was one of the nation’s least competitive health care environments with a dominant payer negotiating with a dominant provider.

An IDFS could align incentives, support value-driven health care and eliminate data silos. Furthermore, such a system would focus the payer and providers on:

  • Reducing low-value treatment and over diagnosis.
  • Shifting services to the most appropriate, cost-efficient settings.
  • Preventing and managing chronic diseases.
  • Implementing more efficient, coordinated models of care.
  • Integrating real-time data to support improved clinical decision-making.
  • Optimizing clinical and financial performance.

How did this payer-provider strategy change the health care landscape in the market?

More than 20 years later, this aligned payer-provider strategy has helped to drastically change the health care landscape. Patients and providers now have easy access to the information they need for efficient and effective care coordination. Providers are able to make measurable changes in their patients’ health and quality of life.

There are now two IDFSs and multiple national insurers competing in Western Pennsylvania. The region’s insurance prices are among the lowest in the nation. Fully insured commercial premiums for employer groups and premiums for individuals covered through commercial insurance products are less expensive in Pittsburgh than in almost every other major market. At the same time, the region experienced improvements in health care quality and considerable investments and innovation in medical science and health care delivery.

What is the potential value of this model to other health care providers?

The success of Pittsburgh suggests that when providers and payers work together to improve quality and reduce costs, good things can happen for patients, organizations and the communities they serve.

As people search for solutions to transform the health care system to produce greater value, the integration of insurance and health care delivery ought to be considered as a central strategy.

How do you think policymakers can support provider and payer collaboration?

Integrated payer and provider systems have the potential to not only manage costs, but also to work together to address critical public health issues, such as the opioid epidemic, to drive reductions in inappropriate prescription drug use, and improve member safety through integrated data that supports clinical decision-making.

As policymakers consider options to improve the health of our nation and reduce health care costs, marketplace structure should be central. They should look for ways to support new models of provider and payer collaborations that enable providers to develop key competencies, such as consumer engagement and member management processes, risk analysis and reimbursement modeling. These competencies are essential for improving clinical quality, patient satisfaction and costs within integrated systems.

Insights Health Care is brought to you by UPMC Health Plan

Diet and nutrition have a hand in chronic health conditions

When you think about treating chronic health conditions, you may focus on therapies to address those diseases. But there are other components to consider when it comes to curing, controlling and preventing illnesses: diet and nutrition.

“What and how much you eat and drink can ease or exacerbate your chronic health conditions. If you don’t have a chronic condition, changing your diet may keep you from developing one,” says Karen DePasquale, LSW, ACSW, associate vice president of Clinical Affairs and Business Operations at UPMC Health Plan.

Smart Business spoke with DePasquale about how diet can cure, control and prevent chronic health conditions, and why employers should use health coaches to encourage this in their employees.

What are some chronic diseases where your diet and nutrition can play a large role?

  • Obesity: Eating more calories than you burn can lead you to become overweight or obese. This can cause serious health issues. Taking steps to address your diet and stop (or reverse) weight gain can positively affect your health.
  • Diabetes: There are many risk factors for type 2 diabetes, including age, race and genetics. But 90 percent of individuals with the disease are overweight or obese. Studies show that lifestyle changes — including weight loss and increasing your level of activity — can prevent or delay the disease’s development, according to the Obesity Society.
  • Cardiovascular diseases: Eating an unbalanced diet high in saturated and trans fats and lacking in fruits, vegetables and polyunsaturated fat can increase your risk of heart disease and strokes. Consuming too much salt can cause high blood pressure, another major cause of cardiovascular diseases.
  • Cancer: A healthy diet with adequate amounts of fruits and vegetables can help reduce your risk for oral, esophageal, stomach and colorectal cancers. Such a diet should also help you maintain a healthy weight, and that can reduce your risk for breast, kidney and endometrium cancers, according to a report by the World Health Organization.
  • Osteoporosis and bone fractures: As you age, your bones can become more susceptible to fractures. To reduce your risk, you should consume adequate amounts of calcium and vitamin D, and make sure you are getting enough sun exposure and performing muscle- and bone-strengthening exercises.
  • Dental disease: The acids and sugar in many foods and beverages can damage your teeth and gums. Limiting these foods can provide protection, as can getting regular fluoride treatments.

If you are at risk for any of these conditions or are dealing with one or more of them, remember that it’s not too late to make a change. Simple changes to your diet, in conjunction with your physician’s recommended treatment plan, can go a long way toward managing your chronic health conditions.

How can health coaching positively impact your workplace?

Having a healthy diet can cure, control and prevent chronic health conditions. Even so, it isn’t always easy for people to change what they eat and drink — especially in today’s always-on-the-go workplace. Employees are busy and can be tempted by unhealthy choices like fast food and vending machines. Sustained motivation through a health coaching program can make a significant difference in helping employees accomplish lifestyle change goals.

Health coaches are supportive, knowledgeable professionals and include licensed nurses, counselors, registered dietitians, social workers and exercise physiologists. They provide one-on-one telephone or online support, as often as needed, to help employees change their lifestyle or manage a chronic health condition that has changed their life. Health coaches help employees identify and tackle challenges to get them on the road to better health by setting goals and finding the best ways for members to reach them.

Offering a health coaching program lets your employees know you care about them, which can have a positive impact on morale and productivity. This type of program can also help you attract new talent and retain extraordinary employees.

Insights Health Care is brought to you by UPMC Health Plan