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Life Health > Health Insurance > Health Insurance

A 2009 Perspective On Employer-Provided Health Benefits

By Randall K. Abbott

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Employer-provided health benefit plans in 2009 will continue to emphasize engaging plan members in how to better use health care goods and services through “financial tension” at the point of care. At the same time, they will promote more aggressively employees’ efforts to improve personal health and reduce risk factors.

This dual focus will form the foundation for health benefit plan design and workforce health improvement in the year ahead. It is also consistent with research conducted by Watson Wyatt and the National Business Group on Health, which demonstrates that top-performing plans are striving to make plan participants both better consumers and healthier individuals.

Employers are working to support plan members when they have a health-related issue, be it a question about health or the need for actual care and treatment. This support is taking the form of education, decision-support resources, tools, programs and plan design changes that will help plan members make informed decisions about their health, their lifestyle and choosing services that provide high-value, cost-effective care.

Education on personal health and well-being remains in the forefront, with 83% of employers offering health risk assessments (HRAs) to help plan members understand their health status and explore ways to improve their personal well-being. A growing number of employers are complementing the HRA with a worksite biometric screening, including the measurement of height, weight, body mass, cholesterol levels, blood sugar and blood pressure. Biometric campaigns, or “Know Your Numbers” initiatives, make data input into HRAs more accurate and provide valuable immediate insights to members on where their health may be at risk. Those at risk can be immediately referred to their doctor or to other resources.

Many employers continue to carry some incentive component as part of their HRAs (about 54%, based on our 2008 study), and biometric screenings are voluntary. A small but growing number of employers are looking to require the completion of HRAs and biometric screenings for plan participation, to more aggressively engage employees in improving their personal health. While this requirement is still emerging, it is growing each year and likely to be more prevalent in the years ahead.

Beyond helping members understand their health status and biometric numbers, employers also are bolstering member awareness of health decision-support tools. These range from the traditional nurse-line and self-care guides to newer resources like online health information libraries. These libraries use a variety of resources from top-notch third party content providers, to advocacy support, to clinical assistance in evaluating diagnoses and treatment plans.

Health advocacy services go beyond the nurse-line to help members with administrative or claim issues, difficulty finding needed specialty resources or preparing questions for an upcoming doctor’s visit. Members faced with a serious diagnosis or treatment plan can access a confidential service that allows them to share their concerns and medical history with a nurse who will then have the case evaluated by a specialized physician.

Data from Best Doctors, one major provider of this service, shows that more than 25% of original serious diagnoses may be incorrect, and that up to 30%-40% of treatment plans should be modified and improved when compared to best practices and evidence-based medicine.

While the use of HRAs and biometric screenings is invaluable, both broad-based and targeted efforts to tackle major health challenges continue to emerge. Employers are promoting and augmenting such wellness and lifestyle improvement programs as smoking cessation, stress reduction, nutrition education and exercise support, and weight management. These society-wide health challenges contribute significantly to poor health, less-than-optimal performance on the job and higher claim costs.

As the need for improved worker productivity becomes even more acute due to workforce aging and economic pressures, the need for these lifestyle improvement efforts will become more pressing–not only to manage claim costs, but also to reduce “presenteeism” (defined as the health-related impairment that erodes on-the-job performance, making the employee less than optimally productive, even though actually at work).

Chronic condition management or disease management continues to be an acute focus of many employers, as is a renewed recognition of the need to manage not only large dollar (catastrophic) claims, but also cases that require coordination of complex care, cases which aren’t generating big expenses today but have the potential to be costly over time.

Plan design trends continue to emphasize patient engagement at the point of care through the resurgence of coinsurance, to emphasize that there is a cost to care beyond a flat copayment of $15 or $20 or a fixed-dollar deductible. In-network services, often reimbursed at 100% just a few years ago, are rapidly being replaced with an 80%-90% coinsurance with a reasonable out-of-pocket limit to cap member costs at an affordable level. Exceptions to this are high-value preventive services, screenings and associated tests, which often are kept at 100% coverage after a modest copayment to encourage the early detection of emerging health risks. Targeted design efforts are being applied to certain services like emergency room services and high-cost imaging, requiring patients to share in the cost with a deductible often in the range of $100 to $150.

On the “new and different” front, many employers are now electing to cover accessible and affordable retail clinics such as Take Care or MinuteClinic as in-network providers, recognizing the challenge of accessible primary care resources in many communities.

Perhaps the biggest shift is the recognition that a health benefits strategy and a sound benefit design are only part of the total health equation. Increasingly, employers are recognizing that any benefits plan must be complemented by a workforce health and productivity strategy that emphasizes the reduction of health risks, improved productivity, fewer lost days and a quicker return to work. Managing health in an unhealthy economy is a critical challenge, not only for the employer’s success but also because it will play a role in returning the American economy to growth and prosperity in these uncertain times.

Randall K. Abbott is a senior consultant and New England practice leader in group benefits and health care at Watson Wyatt Worldwide. He is based in Boston, Mass.

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