Com­men­tary

Rather than fo­cus at­ten­tion — and dol­lars — on get­ting work­ers fit, em­ploy­ers are now ze­ro­ing in on help­ing them man­age chronic ill­ness

Employee Benefit News - - Contents - By Stephanie Ward Stephanie Ward is se­nior re­gional vice pres­i­dent of Cor­po­rate Syn­er­gies, a ben­e­fits con­sult­ing firm.

Rather than fo­cus at­ten­tion — and dol­lars — on get­ting work­ers fit, em­ploy­ers are be­gin­ning to zero in on help­ing them man­age chronic ill­nesses.

There’s no ques­tion it’s in ev­ery­one’s best in­ter­est to have healthy, en­gaged em­ploy­ees. Em­ploy­ees who avoid ill­ness see lower health­care costs, while em­ploy­ers see lower ab­sen­teeism rates.

But there’s a prob­lem with the quest for healthy work­ers: Over the last decade, em­ploy­ers have largely fo­cused on well­ness pro­grams to help their em­ploy­ees get and stay healthy, rather than look­ing at chronic con­di­tions. That’s re­sulted in mixed re­sults for well­ness pro­grams. Sure, there are some suc­cess sto­ries, but more often than not, em­ploy­ers are find­ing that their well­ness pro­grams don’t move the nee­dle on ris­ing health­care costs.

Rather than fo­cus at­ten­tion — and dol­lars — on get­ting peo­ple well and hav­ing min­i­mal im­pact, em­ploy­ers are be­gin­ning to zero in on help­ing em­ploy­ees man­age chronic dis­ease.

It’s a smart de­ci­sion: About 86% of health­care dol­lars are spent on chronic and men­tal health con­di­tions, and 59% of Amer­i­cans have at least one chronic health con­di­tion, ac­cord­ing to the CDC. And there’s a lot of ev­i­dence that shows chronic dis­ease man­age­ment pro­grams work. They can im­prove out­comes in peo­ple with di­a­betes, heart fail­ure, COPD, high blood pres­sure, anx­i­ety and de­pres­sion.

But the way an em­ployer runs a dis­ease man­age­ment pro­gram varies greatly de­pend­ing on the fund­ing mech­a­nism. Self-funded em­ploy­ers are at an ad­van­tage be­cause they can care­fully re­view claims data to see how to track chronic con­di­tions and mea­sure ROI.

On the other hand, fully in­sured em­ploy­ers have less ac­cess to data and likely would turn to their in­sur­ance car­rier’s pro­gram, which is al­ready em­bed­ded into the cov­er­age. Here’s how it works: Car­rier pro­grams typ­i­cally fo­cus on em­ploy­ees with asthma, COPD, breast can­cer, di­a­betes, heart dis- ease, arthri­tis, de­pres­sion, end-stage re­nal dis­ease or women with high-risk preg­nan­cies.

When a con­di­tion is di­ag­nosed, the health in­sur­ance car­rier works closely with the em­ployee, pro­vid­ing tools and sup­port to man­age the ill­ness. The car­rier may pro­vide ac­cess to coun­sel­ing, nurse on­call re­sources and other high-touch ser­vices. The goal is to help the em­ployee:

1. Un­der­stand the con­di­tion and health risks 2. Un­der­stand the doc­tor’s in­struc­tions, test re­sults and course of treat­ment

3. Stay mo­ti­vated in the treat­ment

4. Main­tain com­pli­ance with tak­ing pre­scribed med­i­ca­tion.

Un­for­tu­nately, a car­rier can’t pro­vide de­tailed in­for­ma­tion to the em­ployer, such as di­ag­noses or prog­noses, about who is par­tic­i­pat­ing in any pro­gram. Em­ploy­ers are hard-pressed to gain any more than the per­cent­age of em­ploy­ees par­tic­i­pat­ing in dis­ease man­age­ment pro­grams.

If par­tic­i­pa­tion rates are low, em­ploy­ers can of­fer in­cen­tives; this is nor­mally a cash award, a de­crease in the re­quired em­ployee pre­mium con­tri­bu­tion, or re­duced co­pays and de­ductibles. Some em­ploy­ers also use on-site coach­ing, which re­quires a com­mit­ment from the com­pany to al­low em­ploy­ees time away from work to par­tic­i­pate. A few com­pa­nies are even lim­it­ing plan de­sign op­tions based on par­tic­i­pa­tion in the pro­gram.

Other im­por­tant com­po­nents of a suc­cess­ful dis­ease man­age­ment pro­gram in­clude:

1. Clearly com­mu­ni­cat­ing the ben­e­fits of the pro­gram often

2. Gain­ing sup­port for the pro­gram from se­nior

man­age­ment

3. Cre­at­ing a cul­ture of health

4. Pro­vid­ing em­ploy­ees with the abil­ity to par­tic­i­pate in work­place health pro­grams.

In ad­di­tion to car­rier pro­grams, some larger em­ploy­ers with fully-in­sured plans may out­source cer­tain dis­ease man­age­ment needs to fur­ther man­age health­care costs. For ex­am­ple, a com­pany with a large pop­u­la­tion of younger work­ers may want to pro­vide a more in­ten­sive ma­ter­nity-fo­cused pro­gram to pre­vent hos­pi­tal­iza­tions and other com­pli­ca­tions that would im­pact claims.

It’s worth not­ing that dis­ease man­age­ment has been proven to help em­ploy­ees get healthier, which could im­pact en­gage­ment and ab­sen­teeism. This is an im­por­tant met­ric for fully in­sured em­ploy­ers that are con­sid­er­ing whether to move to a self-in­sured model.

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