With behavioral health conditions impacting one in five Americans, it’s no wonder we’re seeing more employers search for ways to provide members with better access to behavioral healthcare benefits.
Statistics show that many employees, including some that are insured, fail to get the mental healthcare they need. Because self-funded health plans provide plan design flexibility, some plans are taking bold steps to address this growing need. While many are using telemedicine to improve access and lower costs, some employers are treating out-of-network behavioral health treatment as in-network, enabling employees to pay the same amount for treatment regardless of which provider they use. Others are covering out-of-network behavioral healthcare services even when their plan doesn’t cover out-of-network services for other types of care.
When you consider that mental illness has become the greatest cause of disability claims in the U.S., it is not surprising that employers are looking for ways to help employees obtain the care they need.
Significant Action is Warranted
There is plenty of research to show that Americans are not getting the mental healthcare they need. According to Mental Health America, despite having health insurance, 56.5% of adults with mental illness received no treatment in the past year.
Another problem is that behavioral health treatments are rarely classified as primary care, and are regarded instead as specialty treatment. This makes people find an in-network provider, go out-of-network, pay higher out-of-pocket costs or avoid treatment altogether. Claims data from Collective Health shows that more than 40% of the 2017 behavioral health spend was out-of-network, which is many times the amount spent on primary or preventative care.
Members would be well advised to keep an eye out for a new wrinkle in provider billing – facility fees, resembling resort fees often tacked on to daily room charges at upscale hotels. These fees, being charged by some hospital-owned clinics in addition to the charge for physician services, are said to be the result of hospitals acquiring more and more physician practices. They are also one more reason to look closely at provider billing.
For those who simply cannot do without their favorite foods, here’s a list of the things that many of us love, but our hearts wish we would avoid.
Fast Food – Most of it has poor nutritional value, including plenty of fat, calories and processing.
Candy – Go with a small quantity of dark chocolate if you must have some candy, but the sugar just isn’t a good thing for your heart.
Ice Cream – Cardiologists warn that even small amounts of ice cream provide too much fat and sugar – it’s that simple.
Pizza – Pizza nights are tough to beat, especially in cities like Chicago and New York. But unless you make your own, using healthier ingredients, you’re consuming too much fat and salt.
Soft Drinks – These are simply full of sugar and while they may be refreshing on ice, soft drinks are lacking in nutritional value.
Pastries – Few things taste better than cookies, pies and cakes but in high doses, the sugar, fat and gluten can lead to obesity.
Processed Meats – Ham, bacon, hot dogs and other deli meats usually contain lots of salt, fat and even nitrates. Too much salt can boost blood pressure, another risk factor.
With research showing that the average cost of healthcare surpassed $11,000 per employee in 2015, stretching every healthcare dollar is a must. Since self-funding is the foundation from which so many cost control strategies emerge, we encourage you to take this step if you haven’t already done so.
Understand the Needs of Your Group
Since every employer group is unique, it’s imperative that you look closely at demographics, prior claims and medical conditions. The availability of meaningful data is one of the biggest advantages of a self-funded plan, and key to making sure that those with chronic conditions such as diabetes or hypertension are receiving the treatment and attention they need. If your administrator isn’t helping in this critical area, you have the wrong administrator!
Self-funded health plans involve several parts that need to be working together. If you think healthcare is complex, put yourself in the shoes of your members and their families. Programs such as utilization review, hospital pre-certification, disease management and healthcare coaching can go a long way in managing costs. Services like patient advocacy and telemedicine can help members get the care they need in an efficient setting. For example, while office visits cost about $130, a telemedicine visit can be equally effective at a cost of about $40. With so many variables available today, it’s easy to see why customer service and care coordination are as important to your bottom line as they are to your employees.
Education and Wellness
Once a self-funded plan design and professional administration are in place, employee education and wellness integration must follow. Few factors influence healthcare costs more than lifestyle choices and the need to make informed buying decisions. And whether it involves understanding benefits or choosing a high quality, efficient provider, studies show that members need more support. To help in this area, many TPAs are integrating online access to comparative data on costs and providers.
When you consider that we can only manage what we can measure, delivering meaningful information to members, when they need to make a healthcare decision, should result in happier, healthier employees and lower costs for all.
Plenty of people are more than familiar with long driving commutes to work. But, what they may not realize are the negative effects that excessive sitting can have on their bodies. Any expert will tell you how important movement is to one’s cardiovascular health. So, when long driving commutes and desk jobs are combined, the risk of cardiovascular disease certainly increases.
When we sit, not only does the heart have to work harder to circulate blood and oxygen through our systems, but our hips also bend which shuts off the core and sends our bodies into a passive state relying on our structural system to hold us up. Over time, this can lead to spine compression and to your back going out.
So, how do you save your posture without having to find a new job? Experts suggest getting a standing or treadmill desk, if your employer allows. Otherwise, setting a reminder to get up and walk around every 30 minutes can help immensely. If you’re taking a driving vacation or sitting in the car for more than two hours, be sure to find a rest stop so you can walk around and stretch your legs or even do a quick set of kneeling lunges to loosen your muscles. It might also be wise to have an expert look at the seat of your car or your desk chair to make sure you’re doing everything you can to help your posture.
Trade associations report that to respond to growing requests from fitness-minded travelers, hotels are moving well beyond basic spas and fitness rooms. 84% of hotels offered fitness facilities in 2014, but the number of hotels offering in-room fitness equipment has doubled in the past 10 years. Some chains now offer rooms with a stationary bike, elliptical or treadmill plus free workout wear and sneakers delivered to your room. Yoga mats and videos, healthy minibars and room service menus including stir-fried veggies and tofu are growing trends.