While plenty of folks talk about reference based pricing as though it’s a fad that has come and gone, we’re finding more interest from employers all the time. This may be because many like to brand it as another form of disruption, but regardless of how you brand it, reference based pricing is becoming a more important part of our value proposition all the time. It’s becoming more widespread because it enables a self-funded plan to limit costs to an extent that few other measures, if any, can match. This is primarily because by negotiating in advance with hospitals to accept a schedule of fixed payments for certain healthcare services, carrier-sponsored provider networks can be bypassed.
The fact is that while reference based pricing may be considered disruptive by many hospitals, it works. It is a transparent approach that can save a lot of money for self-funded health plans and their members. And finding ways to help self-funded employer plans provide high quality, high value healthcare to their members is our most important job.
While prescribed medications are critical to the management of chronic illnesses such as diabetes, asthma or heart disease, they can only help when taken correctly and research shows that at least half are not taken as prescribed. This not only has a huge impact on the health of individuals but on health plan costs since failure to take medications as prescribed can result in costly emergency room visits and hospital readmissions.
Since failing to follow a doctor’s prescription plan will likely result in higher dollar claims for treatment, examining claims data is the first step to take in order to monitor this problem. Once the employees involved are identified, a health coach or support team can be assigned to help these individuals begin managing and taking their medications correctly. If cost is an issue, which is fairly common in the case of chronic problems, financial incentives or help with prescription copays might be wise.
After decades of preaching to workers about the importance of staying fit and physically healthy, the term worksite wellness is beginning to mean much more to employers and employees alike. Leading companies are expanding their workplace wellness initiatives to address mental health and financial security – key components of their employee’s overall well-being that go way beyond physical health.
The National Business Group on Health shows that a majority of employers are addressing emotional and mental health as well as financial security as part of their overall well-being strategy. Other initiatives, such as support for community involvement and social interaction, are pointing to a growing trend of focusing on the entire person and not just physical health or fitness. Research is showing that addressing physical health is only one way to improve the workplace experience and reduce employee turnover.
More Choice Means Greater Satisfaction
While traditional wellness programs have been more “one size fits all” and lacking in personal appeal, some employers are encouraging employees to do the things they like to do by giving employees a flat dollar amount to spend on a gym or pool membership, personal trainer or other self-defined activity they find rewarding. Volunteering to help with community causes or enrolling in educational classes are not out of the realm of possibilities, since these activities can do a lot to help an employee gain a healthier perspective on work and life.
When choices are made by individuals and not for them, better decisions often result. As people share their experiences with others, the impact on a company’s culture can be extremely positive. Better well-being becomes an important priority for everyone and not just those who like spending time on treadmills or yoga mats. From the employer’s perspective, objectives can expand beyond healthcare cost savings and increased productivity. As an example, offering health coaching is a great way to focus on the needs of individuals rather than the group as a whole. It can help companies address emotional and mental needs as well as physical needs.
If worksite wellness is a priority for your organization, this might be a good time to review the goals of your program and then to make sure the activities you are offering are in line with those objectives. There is a lot more to be gained from worksite wellness than lower medical claim costs and redefining wellness may be just what your organization needs.
The American Cancer Society reminds us that more skin cancers are diagnosed each year in the U.S. than all other cancers combined. Most are caused by too much exposure to ultraviolet (UV) rays, most of which come from exposure to the sun. One thing to remember is that you don’t have to be spending a day at the pool to be at serious risk. Simply staying in the shade will make a huge difference. If you do want to catch some rays, slip on a shirt, wear a hat and apply sunscreen with a SPF value of 30 or more. UV blocking sunglasses will help protect the delicate skin around your eyes and help you avoid certain eye diseases as well.
A study of nearly 700 individuals with coronary artery disease has revealed that hearts in men and women react differently to a temporary reduction in blood flow to heart muscles, a common symptom caused by stress. While some men may experience an increase in blood pressure and heart rate, making their heart work harder, about 1 in 5 women experienced constriction in their smaller blood vessels, which can cause more serious heart complications. American Heart Association representatives recommend physical exercise as a way to manage mental stress. Exercise will make blood vessels dilate, counteracting the constriction seen by some of the women who participated in the study. Regular exercise, like a daily walk or run, can go a long way in helping us cope with mental stress.
Thanks to a new system approved recently by the U.S. Food and Drug Administration, Medicare patients with diabetes are able to monitor their glucose levels without sticking their fingers. The first-of-its-kind system reads glucose levels through a sensor placed on the back of the upper arm. Sensors, which can be worn for 10 days, are priced at $36 while a handheld reader, placed over the sensor to obtain real-time readings, retails for about $70.
Even though on-site clinics are not revolutionary, the announcement by Apple seems to have captured more attention because of the excitement generated by newsmakers Berkshire Hathaway, JP Morgan Chase and Amazon. Apple, currently working to add medical personnel, expects the clinics to be available at their Cupertino, California headquarters this Spring.