Empowering Employees: Big Talk, Little Action

telemedicineTelemedicine offers a lot of potential for everyone – added convenience for busy families and lower costs than a traditional office visit. But as helpful as this service can be, it will only make a difference if it is used.

Low utilization is not unique to telemedicine. It’s a common problem with many new, well designed and well-intended health care services. Encouraging plan members to actually use new offerings is a challenge for employer groups, large and small. And while utilization is often higher in self-funded health plans, all employers need help turning talk into action. Here are a few ideas to consider:

It’s all about them – With health care consuming more of everyone’s income and attention, we all have a vested interest in our benefits. And while wonderful tools like telemedicine keep coming to the table, you need to look at these offerings from your member’s perspective rather than your own. Talk with your employees; ask if a service will help them and listen to their feedback. If it can add real value to your employee’s lives, utilization will follow.

Talk about health, not cost – Research indicates that when it comes to their health and wellbeing, there are many things members would prefer to hear about than fees and costs. A majority are interested in improving their health. It takes time, but focusing on current health risks and personalizing communications as much as possible will help members want to get more engaged.

Educate to empower – Transparency tools and online portals are no different than other modern advances. If people don’t understand them, they will never catch on. Like telemedicine, unless employees understand how to use it and when they can use it, they will never realize the benefit of having an experienced, board certified physician, with access to their medical records, available to help them 24/7.

While it seems that other new disruptive innovations, such as Alexa, catch fire overnight, they do take time. Since your employee communication budget likely pales in comparison to those driving consumers to Amazon, talk with your TPA about new ways to zero in on the needs of your employees. Doing so can lead to increased utilization and a happier, healthier workforce in 2018 and beyond.

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Commonsense Reporting Bill Introduced

commonsense-reportingIn October, a bipartisan group of senators introduced a bill that would ease the ACA reporting mandates for employer-sponsored health plans. The bill would roll back the reporting requirements of Section 6056 and replace them with a voluntary reporting system. The bill would also allow payers to transmit employee notices electronically rather than having to send paper statements by mail.

While self-funded health plans must now comply with Sections 6055 and 6056, it is not yet clear how the bill would affect Section 6055 requirements. Senators Rob Portman of Ohio and Mark Warner of Virginia, sponsors of the bill, say their proposal would give the government a more effective way of applying premium tax credits to consumers who purchase insurance through an Exchange, something the administration has been trying to accomplish.

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Bundled Payments Yielding Good Results

bundled-paymentsIn a previous newsletter, we discussed bundling introduced by Medicare which focuses on orthopedic and cardiac procedures. Through the mandatory initiative for comprehensive care for joint replacements (CJR), which became policy in 2016, some 800 hospitals are participating in the program.

While some sources report the results of bundling as mixed, Medicare reports that joint replacement payments increased by approximately 5% nationally, but decreased 8% for BPCI participants. One large health system achieved a 20.8% episode decrease and another reported a significantly shorter prolonged length of stay – a sign of fewer complications resulting from surgery.

Providers, both acute and post-acute, shared in the savings and indications are that post-acute savings were achieved because their care was bundled, placing these providers at risk. Even though efforts to repeal and replace or modify the Affordable Care Act are on hold, more healthcare providers and payers can be expected to embrace bundling going forward.

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Not All Medical Tests Are Helpful

medical-testWhile going through a recent physical exam with my family physician, I asked him to review a newspaper ad sponsored by a major teaching hospital offering a number of different health screenings, many utilizing ultrasound technology. A discount was being offered – the greater number of tests you purchased, the greater your overall savings vs. per-test pricing. I asked questions about the tests and whether any of them would be useful to me and was quite surprised (and pleased) when my doctor said that based on my relatively good health, he saw no need for the tests.

The Congressional Budget Office estimates that up to 30% of U.S. health care expenditures go to tests, procedures, doctor visits, hospital stays and other services that do not improve patient health. The American Board of Internal Medicine and ABIM Foundation have organized a campaign, called Choosing Wisely , to help people get medical treatment they need and avoid care that is not only potentially costly, but medically unnecessary.

To this end, 9 major physicians groups have identified 45 common procedures and tests that are often not needed and sometimes harmful. A few examples include cardiac stress tests, cancer screenings for dialysis patients, x-rays and other imaging at the first occurrence of back pain and brain scans for patients who have fainted, but have no other relevant symptoms.

Experts say that when it comes to determining the need for tests, communication and shared decision-making leads to the best outcomes. For more information on overuse or misuse of medical tests and procedures, go to choosingwisely.org. To find information on how to talk to your doctor and ask questions about tests and procedures, visit consumerreports.org.