Health Insurance Times

A company's wellness strategy should do more than help employees grow healthy. 
It should help your business grow healthy.  The right information delivered to the right people at the right time can lead to better decisions which can lead to better health.

It's about personal responsibility

According to the Centers for Disease Control, about 50% of all Americans live with at least one chronic condition -- like diabetes or heart or lung ailments.  People with chronic diseases account for more than 75% of the nation's medical care costs.  Most of these conditions are connected to unhealthy lifestyle choices, i.e. diet and exercise.

If people are determined to live unhealthy lives, no government programs nor any amounts of money can possibly fix this problem.  When all is said and done, this is a matter of personal responsibility.

We hear more and more about wellness with each passing day

Wellness is a lifelong journey ... It's about changing behavior ... and that ain't easy. 

We have many well-intentioned sources touting 'wellness' with some mystical ROI that
is impossible for smaller companies to quantify.  They talk about ... healthier and more productive employees .... lower health insurance costs ... reduced absenteeism and reduced presenteeism ... and much more.  Does this sound at all familiar? 

BUT here's what's missing ... 

How do you get started?  How do you ease into something, about which you have no experience, without committing a substantial amount of time, money and resources? 

Before we delve into the savings aspect, let's understand that dental insurance plays a critical role in your overall health and disease management program.  Untreated gum disease can lead to blood clots which can further lead to stroke and heart disease.  This short video on the importance of dental hygiene shows you more. 

A major dental insurer states that only 63% of employees will visit their dentist once in any given year.  Less than 45% will have two or more visits.  The non-users or one-time users are "missing the boat" when it comes to their overall well-being.  If you haven't already clicked on the video link above, why not click on it now and learn how regular dental exams and cleanings will help improve your health.

Now let's get started on the "50% savings" thought process ...

If you regularly saw your dentist and received the following dental services ...

• Dental exam every 6 months

• Teeth cleaning every 6 months

• Fillings

• Emergency (palliative) care

• General anesthesia (as needed)

• Bitewing X-rays every 12 months

• Full mouth (panoramic) X-rays every 60 months

• Other X-rays (as needed)

• Periapical (single tooth) X-rays (as needed)

• Flouride treatments (child under age 14) 1 time in 12 months

• Sealants for a child under age 19

• Space maintainers for a child under age 14

• Consultations (up to 2 in a 12 month period)

Wouldn't these services greatly lessen your need for major services in the future? 

In other words, consider not buying the major (higher priced) services if you're doing everything you can to not have to use them.  Keep the money in your pocket for "when and if" rather than give it to the insurance company for "probably not likely."

Your employer can include this option in your group dental insurance plan that, on average, saves 50% (both you and your employer) on your monthly insurance costs.

The accompanying Price Waterhouse Health Research Institute May 2011 report into “Medical cost trends for 2012” is about as in-depth as it gets.  You owe it to yourself and your company to find the time to read it. 

The projected increase in medical costs for 2012 is 8.5%.  The actual rate increase your company might experience takes into account many other factors, one of them being the age of your employees.  Geographical location is also important as medical costs vary in different areas (cities) and your industry (SIC Code) is another factor. 

How long can you handle 8.5% increases and still remain in business?  OK, so you’ll pass along these increases to your employees.  Do they get 8.5% pay increases?

Obviously, something has to give and that means your future health plans will have increasingly higher co-pays and deductibles.  Your employees will be facing higher and higher financial risk as will you if you’re helping them with the deductibles. 

Q: So how do we reduce or contain that financial risk?
A: We use ongoing employee education focusing on two factors: 

     1)  The role of chronic disease in healthcare costs
     2)  What employees need to do to reduce their financial risk

Q: Why the focus on chronic disease?
A: According to the Centers for Disease Control (CDC), chronic disease accounts for  
    75% of all health costs.  Chronic diseases are both manageable and preventable.

In the example shown above, the employer’s previous insurance had a $15 office copay and a $250 hospital copay HMO with 60 employees on the health plan.  Premiums were roughly $400 for an individual, $800 for a two-person and $1200 for the full family, split 75/25 between employer and employee. 

By moving to the $2,000 deductible plan, the premiums dropped by 25% or about $144,000/year.   The employer was willing to help his employees with the bulk of that deductible ($1500 for when/if expenses occur) provided the employees were willing to engage in the targeted health activities.

Here’s how it worked.  Employees pay the 1^st $500 of the deductible with the employer paying part or all of the remaining $1500 based on which health activities they engaged in.  If the employee completes the Health Risk Assessment, the employer pays $300 of the $1500.  If, in addition, the employee completes the Primary Care Physician Visit, the employer is obligated for another $300 and so on up to the limit.

The more health activities completed, the less the likelihood employer and employees will be obligated for deductibles. The employees will become healthier which benefits everyone.

The extra cost to the employer?  $3600 or 2½% of the annual savings.

If you already have a Health Reimbursement Arrangement or HRA, you’re probably giving away the reimbursement.  When employees earn that reimbursement, everyone wins.

This is an excerpt from an article I wrote for the February 2011 Issue of National Healthcare Reform Magazine.