A new survey of U.S. employers has found substantial interest in “consumer-driven” health care strategies and, to a lesser extent, wellness initiatives among big and small employers alike, but only limited implementation so far.
The 2006 UBA Employer Survey, sponsored by United Benefit Advisors, covered 1,674 employers of all sizes, including 52 in Rhode Island, according to Robert F. Calise, a principal at The Cornerstone Group, UBA’s only member in the state.
Companies were asked about their workers’ attitudes toward rising health care costs and ways to address those costs, how they communicate with workers about these matters, what wellness and disease management programs they offer and the range of benefits in place.
The most significant finding, said David LoCascio, co-founder of UBA, is that “there are far fewer differences in either current or desired services among employers in different industry groups or with differing numbers of employees than was commonly assumed.”
“The increasing applicability of Web-based solutions and the growing sophistication of benefits advisers,” he added, “have enabled employers of all sizes to have access to tools and services that were previously available only to large employers.”
New Web-based tools can empower workers to manage their own health care in ways no one imagined just a few years ago. They can learn how to manage chronic conditions such as asthma and diabetes. They can compare benefit plans, in detail, to determine which will cost them more based on their historical medical usage. They can look up cost and quality information about doctors and hospitals to ensure they get the best care at the best price.
Just as important, new strategies that benefits advisers are promoting allow employers to reward workers who show they care about staying healthy and saving money – whether it’s by using the Web tools, or by participating in wellness programs.
In Rhode Island, for example, one “well-known” local employer is implementing a new health plan on June 1, Calise said, that for the first time requires workers to contribute toward their premiums – 20 percent.
But if workers who smoke commit to an eight-week smoking cessation program being paid for by the company, they can cut their contribution in half, Calise said. (Nonsmokers can achieve the same by getting a doctor’s note certifying that they don’t smoke.)
To get the other 10 percent of the premium covered, workers must visit their primary care doctor and undergo the recommended basic screenings – blood tests as appropriate, a Pap smear, a mammogram, a colonoscopy, whatever is appropriate for their age and gender.
“They’re forcing the employees to take a hard look as to whether or not they want to make payments toward their coverage and continue doing what they’re doing, or make an effort to be healthier,” Calise said.
In the UBA survey, 76.3 percent of employers reported that their workers are “very” or “somewhat” aware of what’s going on in American health care and how fast costs are rising, 82 percent said their workers could effectively choose prescription drugs, and 78.2 percent said their workers would be able to participate in programs to manage chronic conditions.
Yet despite the fact that those things could “directly impact both the cost and quality of the medical care” workers receive, the survey found, “many employers do not currently provide the educational resources or preventive care programs to assist their employees in this area.”
In fact, only 36.2 percent of employers provide online tools to look up prescription drug costs, 18.3 percent provide hospital cost or quality information online, and only 24.5 percent provide Web-based chronic disease management tools – now widely available through insurers.
Large numbers of employers said, however, that they’d like to provide such Web tools either next year or “someday,” so UBA predicted that in the near future, use of those tools “will likely increase substantially.”
As for financial incentives such as the one described by Calise, employer support for them is substantial: 53.4 percent of survey respondents said they believe workers who make a “reasonable effort” to manage their chronic conditions should get some kind of cost incentive, and only 14.3 percent said they shouldn’t (the rest weren’t sure).
Implementation, however, remains sparse: Only 7.3 percent of respondents provide financial incentives to participate in a disease management program, 10 percent reward workers for improving their health, 10.9 percent reward them for using lower-cost providers, and 7 percent provide incentives to complete a personal health risk appraisal.
And even looking at next year, employers aren’t quite ready to jump into wellness initiatives. Only 17.9 percent said they’d start a smoking cessation program, for example, 15.6 percent said they’d start a weight control program, and 14.8 percent planned health risk assessments.
Yet both LoCascio and Calise said things are changing.
“We have reached a tipping point regarding employer involvement in helping to manage the health of its work force,” LoCascio said. “The approach of hoping the physicians and/or the insurance companies would effectively intervene to improve the health of its employees has not worked, and employers are increasingly assuming more responsibility and control.”
Calise said it’s not a matter of whether employers should be responsible for their workers’ health – the reality is that they’re cost-effective, because “employers that engage actively in this type of communication will find they end up with healthier employees.”
So more and more, benefits companies such as Cornerstone spend less time selling health plans and more time explaining the new strategies and helping companies implement them.
“We’ve become much more of an employee education organization, a communications organization, than we are insurance brokers,” Calise said. “The pendulum is shifting.”
The complete UBA survey can be purchased at www.benefits.com.
