Following the many hardships caused by Covid-19, members of the House Education and Labor Health Subcommittee have asked Congress to make it easier for Health Savings Account holders to obtain some low or no-cost mental health care before meeting their deductibles. In response to the pandemic, Congress allowed first-dollar coverage for telehealth. Members of the committee would like to make this option permanent and include access to worksite clinics as well. With estimates reflecting a nearly four-fold rise in the number of US adults reporting symptoms of depression or anxiety compared to a year ago, we can expect calls for help to continue.
You might be surprised to hear that millennials represent one third of the American workforce, but Pew Research Center confirms it. If your health benefit plan hasn’t adapted to the needs and lifestyles of these young people, you’re missing an opportunity to boost retention, build loyalty and enhance wellness.
For starters, it’s important to realize that 45% of young adults age 18 to 29 do not have a primary care doctor. They do, however, have a smartphone and you can bet they use it to access the internet constantly. With online sources like WebMD offering so much healthcare information, it’s no wonder that millennials are likely to self-diagnose and even treat one another at home before seeing a doctor. If young people can find much of the healthcare information they need in the palm of their hand, you can bet they expect to find benefits and enrollment information easily accessible as well.
They Want Information Now
Just like so many of us who have come to expect an immediate response to everything, millennials who do need a doctor expect the visit to happen quickly and easily. According to PNC Healthcare, this explains why 34% of millennials prefer to use a retail clinic rather than waiting several days to see a primary care physician in their office – a rate twice as high as baby boomers. It would also seem to point to an increased use of telemedicine.
Cost Matters to Millennials
Millennials face more than their fair share of financial pressures and take their finances seriously. Surveys show they are more willing to request a cost estimate prior to choosing a treatment option than baby boomers or seniors ever were. This not only makes cost transparency tools important, but it’s a very positive trend that should contribute to lower claim costs going forward.
Whether it be treatment options, provider access or cost of care, the demand for health and benefit plan information will only increase as more and more millennials enter the workforce. In order to respond to change, self-funded employer groups will need the resources of an independent TPA that can combine the right plan design with more personalized, interactive communications and more innovative ways for younger employees to access the more personalized care they will need going forward.
In at least one big city, a major carrier is providing 100% coverage to public employees for MRIs, CT Scans and other imaging services only when free-standing, non-hospital based facilities are used. What do you know? Independent TPAs have been helping self-funded health plans do things like this for years.
Too many people have long considered rising health care costs to be a condition we simply must live with. Fact is there are alternatives, most of which can only be implemented when the plan’s best interests are first and foremost.
Detailed Reporting Needed
In contrast to a fully-insured plan or self-funding with a carrier-owned ASO, using an independent TPA enables the plan to make informed decisions based on detailed reporting – reporting that the plan owns.
There is no secret to controlling plan costs. It requires discipline and the tools to monitor individual parts of the plan, such as prescription drugs, imaging, chronic disease management and more. Analyzing expenditures such as these can yield huge savings over the course of a year, but only when your administrator is free of carrier or provider affiliations. Having checks and balances in place can make all the difference.
Telemedicine 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.
When it comes to improving the health and well-being of your employees, it’s easy to get caught up in trying to be super creative or search for that magic bullet that automatically boosts engagement and changes behavior. If only it were that easy!
Like any other important business initiative, work-site wellness and health management must begin with a plan, a budget and a strategy. Your plan needs to be based on realistic goals and objectives and executed strategically over the long-term. Most importantly, your plan must be designed to benefit everyone and taken to heart at every level of the organization, top to bottom. If health management is not lived by leadership, others will never take it seriously.
Numbers Seldom Lie
Recent surveys by Towers Watson and the National Business Group on Health show that fewer than 1 in 5 companies have defined a health strategy for their organizations. Surveys also show that in 2014, companies “working” their plan reported per employee healthcare expenses nearly $2,000 lower than companies doing little in the area of health management.
Perhaps the most meaningful numbers in your plan are those that rise to the surface through biometric screenings. Identifying each individual’s health risks is the ingredient that truly can change behavior, help fight chronic disease and improve quality of life. Relevant, personalized health data can make the difference between talk and action, and ultimately, between estrangement and engagement.
Never Stop Communicating
Virtually every employer group will consist of those who are already actively engaged in their health, a similar number with little or no interest and the majority who may not be actively engaged but can be influenced over time. The key to a successful health strategy is consistent, honest communication – telling employees what your program includes, why the program is being made available, how they can benefit and when they need to get involved. Communication is critical for those who come on board, especially when incentives are included. Keeping things simple and fun will always generate better results and help keep the focus on people’s well-being rather than the company’s bottom line.
As a result of the new information reporting requirements under the Affordable Care Act (ACA), employers may be fielding questions from employees about the different forms they are receiving with information about their health coverage. The following questions and answers for employees may be helpful:
1. What are the health care tax forms that employees might receive?
Employees may receive one or more forms providing information about the health care coverage they had or were offered during the previous year, including:
- Form 1095-B, which is furnished by health insurance companies, small self-insuring employers, and other providers of minimum essential health coverage.
- Form 1095-C, which is provided by applicable large employers (ALEs)–generally those with 50 or more full-time employees, including full-time equivalent employees.
Individuals that enrolled in coverage through the Health Insurance Marketplace will receive Form 1095-A.
2. How do employees use the information on these forms?
An employee uses the information on these forms to verify that the employee, his or her spouse, and any dependents had minimum essential health coverage for each month during the prior year and to report that coverage on his or her federal income tax return. Employees that did not have minimum essential health coverage may be liable for an individual shared responsibility payment.
3. Can employees file their tax returns if they have not received these forms?
Yes. Employees should not wait for either Form 1095-B or 1095-C to file their individual income tax returns. Other forms of documentation that may assist in reporting health coverage include insurance cards, explanations of benefits, and Forms W-2 reflecting health insurance deductions. (Employees enrolled in Health Insurance Marketplace coverage will need the information on Form 1095-A to file a complete and accurate tax return.)
4. Should these forms be attached to individual income tax returns?
No. Although employees may use the information on the forms to help complete their tax returns, these forms should not be attached or sent to the IRS. The issuers of the forms (e.g., employers or health insurance companies) are required to send the information to the IRS separately. Employees should keep the forms for their records along with other important tax documents.
5. Who should employees contact with questions about these forms?
Employees should contact the provider of the form (e.g., the employer or health insurance company), not the IRS, with questions about Form 1095-B or 1095-C. For questions about Form 1095-A, employees should contact the Health Insurance Marketplace.
Our section on Information Reporting provides more information on the requirements for employers.
With the Supreme Court decisions and regulatory challenges of 2015 behind us, it’s time to catch your breath and resolve to take better control of your health care benefit plan. Here are a few things to think about as you contemplate the New Year.
Look at TeleHealth – Many companies, large and small, have added telehealth to their healthcare plans in order to provide plan members with easier access to care. Email, smart phones and video physician consults are being used with increasing frequency to bring patients and physicians together in more cost efficient settings.
Employee Well Being – Concerns about the impact of chronic disease on plan costs and employee well being have encouraged more and more employers to introduce worksite wellness. From various forms of health promotion to disease management, these programs can foster better health, help prevent chronic disease and ensure appropriate medical treatment for those with chronic conditions. To learn more or to determine what type of wellness program can impact your cost drivers, talk to us today.
Network or Not – If providers in your area are comfortable with pricing tied to an index, such as Medicare, reference based or “cost plus” pricing is an alternative that can deliver significant savings and true cost transparency. Depending on the makeup of your group and your community, direct contracting with a hospital or provider group could be another win-win. In certain areas, options such as these are proving more effective at containing costs than traditional PPO networks.
Transparency Tools – Speaking of cost transparency, we’d be happy to speak with you about “Real Time Choices”, a new mobile app from AHDI that we are helping employer groups implement. With a website and mobile app displaying easy to follow “traffic light” graphics, Real Time Choices enables members to compare prices for more than 200 common health procedures. It’s a system that gives members data to make informed decisions – convenient access to data members have always lacked.
Still looking for that one good idea? How about managing diabetes better? “Real Time Health,” another AHDI product, includes a cellular based glucometer and a 24/7 care support system designed to encourage and motivate members to do what’s needed to control their condition. Managing at-risk groups, such as diabetics, is one way you can improve lifestyles and control costs in the New Year.
Next month marks the five-year anniversary of the Affordable Care Act (ACA). While many of the requirements for employers and group health plans are already in effect, the questions continue to roll in. Here’s a look at five of the most common questions and answers surrounding the law:
According to a recent Wall Street Journal article highlighting the personal experiences of a doctor and lawyer who took his son in for a non-emergency CT scan, the answer would probably be ‘not anytime soon.’ The piece is an excellent example of what TPAs see every day.