Communication and helping plan members get the most out of their health plan should be an all year round endeavor. Surveys continue to indicate that even highly educated employees describe benefits, insurance and the enrollment process as “very confusing.”
Consider academic research by the Commonwealth Fund and a recent study by Accenture. While one points to higher deductibles and co-pays as the leading financial barrier to medical care, the other cites low health literacy as a hidden cost adding billions in administrative expense to our healthcare system. While it may never be possible for your plan to do away with co-pays and deductibles, high performance TPAs are doing many things to help plan members make more informed healthcare decisions. Here are a few ideas.
1. Simplify Summary Plan Descriptions – Remember that these are more than compliance documents. They are communication pieces and need to be written so that regular people can read them. Make it easy for employees to find information on eligibility, how they enroll, what the plan covers, what isn’t covered and how to file a claim. Move as much legal information as humanly possible to the end.
2. Put an End to Boring Content – To make things easier on the eyes and draw attention to information people care about, use different kinds of headings and add visuals or infographics to any benefit-related communications. Include links to your TPA’s website or other websites that employees can learn from. You don’t need a Hollywood producer to use video clips and after all, video is pretty much all that younger people look at these days. Seriously!
3. Create a Decision Support Taskforce – It sounds challenging, but look outside HR to recruit a team of individuals who feel comfortable with your health plan and healthcare in general. Let people know they can reach out to these individuals with questions about plan options, coverage, how to file a claim, provider networks, etc. People will appreciate this, especially your younger employees, who studies show are particularly confused and stressed over everything insurance related.
Improving your communications can make people feel much more confident about the decisions they have to make. You don’t have to tackle everything at once and even a little progress will improve morale and help people avoid making decisions they may regret later.
According to the Centers for Disease Control, more than 30 million Americans have diabetes – a chronic condition that happens when your body doesn’t produce enough insulin or process sugar efficiently. The surprising thing is that about 7.5 million people are diabetic and don’t know it!
Doctors say if you’re over 45 years of age, are overweight or diabetes is part of your family history, you should be screened regularly. If these characteristics don’t apply, you may want to talk with your physician if you demonstrate any of the following symptoms:
- Increased need to urinate
- Being very thirsty or more hungry
- Bleeding or swollen gums, receding gum line and mouth pain
- Bruises and cuts that take a long time to heal
- Losing weight without trying
- Increased fatigue
- Dizzy or fainting spells
- Yeast and fungal infections
- Dark spots around your neck and armpits
- Tingling or numbness in your hands and/or feet
- Itchy, dry skin
There are several steps you can take to prevent or control diabetes, but like most serious illnesses, early detection is critical. Diabetes or pre-diabetes can be determined by a simple blood test.
As public health officials work to identify a respiratory illness putting people who vape in the hospital, negative reports continue to frighten parents. In the last month or so, two young people have died in Illinois and more than 20 others have been hospitalized throughout the state. The news is similar in other states, as more than 190 hospitalizations were reported by the Centers for Disease Control and Prevention. State and federal health officials are searching for answers, including details on what these people vaped.
While manufacturers say their e-cigarettes were always intended as an alternative to cigarettes for adult smokers, legal challenges are being directed at manufacturers for aggressive marketing to teenagers.
Non-technical staffing company Randstad US reports that 79% of employers offer casual, business casual or no dress code at all. Even investment bank Goldman Sachs has reportedly relaxed its dress code in response to the changing nature of workplaces. While most employers are considering increased flexibility to be a welcome benefit, many employees appreciate being able to save money on their wardrobe and related expenses such as dry cleaning.
Some mega-employers manage clinics on their own while others outsource to clinic vendors or healthcare systems. Many provide clinics within their own facilities, but some offer near-site locations and even share a near-site clinic with other companies. Regardless of which model is preferred, more organizations with 5,000 or more employees are deciding that on-site or near-site clinics can make primary care more convenient and affordable for everyone.
Some of these clinics offer pharmacy services and many have expanded to offer services such as physical therapy, telehealth and even behavioral health. One benefit that clinic operators often emphasize is that by making primary care convenient to employees, and in many cases their family members, fewer employees will neglect primary care because of cost or the inability to take time off to see a doctor.
Worldwide, 226,000 people have signed up with the British charity Veganuary, agreeing to try a vegan diet free of all animal products. While some try vegan for one or two meals per day, others have gone full scale. Some are doing it for environmental reasons while others are concerned about animal welfare and, of course, their health.
Investment bank Morgan Stanley recently hired a Chief Medical Officer. General Motors made the Detroit-based Henry Ford Health System the only in-network option for 24,000 salaried employees in southeast Michigan. And, Apple joined many other large employers in using on-site clinics to provide more personalized care. These tactics are being used to address a combination of risk factors contributing to costly chronic conditions like diabetes, heart disease and obesity.
Filling Voids in Wellness Programs
We all know how hard it is to change lifestyle habits. While traditional wellness programs can offer great tools and improved access, more and more employers are realizing that to boost engagement and keep it from fading over time, you must tailor a program to the needs of each individual.
This level of involvement, sometimes referred to as condition management, includes more personal involvement and communication. Providing guidance and support on nutrition, exercise, stress management and other concerns can help at-risk employees overcome the challenges that have kept them from enjoying their best life.
Walmart is requiring employees to use certain hospitals for costly procedures, such as spine surgeries. Requirements like this are typically accompanied by an assurance that the plan will cover the full cost of the procedure, including travel, when applicable. In an effort to make sure plan members receive high quality, cost-efficient care and weed out unnecessary costly procedures, Ford struck a single-hospital deal earlier in 2018 and the State of North Carolina recently announced its intention to take similar cost-cutting measures for its 727,000 members.
In order to address a sleep shortage that is hurting productivity for U.S. businesses, the American Academy of Sleep Medicine has introduced an online wellness program to help employees track the quantity and quality of their sleep. Employees log their time online or upload data from a fitness tracker such as a Fitbit. With the CDC linking sleep to chronic illnesses such as Type 2 diabetes, heart disease and depression, researchers hope to help employees set a goal and improve the quality of their sleep.
Technology giant Apple reported recently that thousands of hip and knee replacement patients are using Apple Watches and a new health app, MyMobility from Zimmer Biomet, to share health data with their surgeons during treatment and recovery. The app is being used to provide physicians with data about the patient’s heart rate, number of steps taken and time spent standing continuously, rather than having to rely on traditional in-person visits.