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All You Ever Wanted to Know About Insurance

We are trying to keep "healthier" employees from becoming higher-cost claimants.

Trying to keep ‘healthier’ employees from becoming higher-cost claimants: a strategy for the total cost of care includes focusing on lower-cost claimants. 

When employers assess ways to control health care costs, one segment they can’t overlook is their “healthy” populations. These employees may not have complex chronic or catastrophic needs. Yet, they still could demand a strategic approach that focuses on wellness and proactive, personalized care — helping employers more effectively manage their total cost of care.

Data shows that 84% of employees are generally healthy yet still generate 56% of medical costs at a rate of $50,000 or less per employee per year. While an employer may consider that segment a healthier population — especially when combined with the 14% of the population that doesn’t generate any claims — those employees still may need the right programs in place to help keep them in that category.

3 Key Takeaways

  1. When employers assess ways to control health care costs, one segment they can’t overlook is their “healthy” populations.
  2. Building wellness programs that are simple, integrated, and relevant for employees can foster their engagement with the health care system.
  3. UnitedHealthcare’s Personal Health Support 3.0 care-management platform is built on an analytics model that looks to maximize medical savings by combining value drivers and engagement.

“From a cost perspective, this group is a critical population to manage because you want to sustain their health and the percentage of employees generating no claims, while at the same time, you’re working to ensure those generating claims don’t reach chronic or catastrophic levels,” says Dr. Brenda Bruns, Chief Medical Officer, Enterprise Health Care Value, UnitedHealthcare. “Having the right strategies can help create a health care system that engages each employee at the right time on their journey, whether they’re generally healthy or dealing with a chronic condition.”

To help manage costs and sustain outcomes within this segment of employees, employers can:

  • Focus on building a culture of wellness and employee engagement.
  • Prioritize proactive and personalized care management for employees most willing to engage and generate the most cost savings.

Build a culture of engaged wellness

Employee wellness programs are not new, but the challenge is typically employee engagement, whether by the choices employees make or discouragement they may feel from an overly complicated system. Building wellness programs that are simple, integrated, and relevant for employees may generate results, as these examples from UnitedHealthcare programs have shown:

  • Participating employees are three times more likely to reduce blood pressure risk.
  • 49% of participants have quit smoking.
  • 82% of participants have lost weight.

 

Of course, creating employee awareness of these programs often is critical.

“‘If you build it, they will come’ doesn’t work for wellness programs,” says Dr. Gerald Hautman, Chief Medical Officer for UnitedHealthcare National Accounts. “Employers can help build a culture of wellness by internally marketing these programs to their employees as aggressively as they market their products to customers.”

Employers offering a range of qualifying fitness and activity options and celebrating employee successes can go a long way in building an overall employee wellness culture that can have multiple benefits to an organization. That’s where more on-site resources can help. Regular workplace access to lunchtime fitness, yoga, or physical therapy options can enhance day-to-day productivity and help avoid more costly and prolonged absences for preventable conditions.

“Different people are motivated by different things,” Dr. Bruns says. “For some, it might be healthy recipes, while for others, it might be a fitness app. To help improve results, employers should consider taking the time to target their offerings.”

Implementing proactive, personalized care management

Those participating in wellness programs are proactively choosing to engage with the health system. Engagement may be more passive and indirect for many employees, putting some onus on employers and insurers to build the best system possible when that engagement occurs.

Traditional care management programs identify employees for participation or outreach based on a hierarchy of medical conditions or events. Newer models, though, review all employees continuously for care-management outreach. The models review all participants based on their total savings opportunity across more than 100 conditions, with employees identified for outreach based on cost impact and likelihood to engage.

“‘If you build it, they will come’ doesn’t work for wellness programs,” says Dr. Gerald Hautman, Chief Medical Officer for UnitedHealthcare National Accounts. “Employers can help build a culture of wellness by internally marketing these programs to their employees as aggressively as they market their products to customers.”

With employees making less-than-optimal health care choices 41% of the time, a care-management program that focuses on timely outreach and proactive engagement may lead to the right care for those generating the majority of health care claims. UnitedHealthcare’s Personal Health Support 3.0 care-management platform is built on an analytics model that looks to maximize medical savings by combining value drivers and engagement. Here are the three components of the platform’s formula designed to help generate the most substantial outcomes and savings:

  1. Value drivers are interventions to help close gaps in care and reduce costs. They provide insight into clinical intervention opportunities, enable consistent care management among nurses, and are generally simple to document and report to maximize the benefit to employees.
  2. Likelihood to engage index uses predictive models based on employee attributes and historical enrollment data to prioritize communication efforts. It looks at employees and determines how likely they are to engage in programs and successfully close gaps in care.
  3. Value opportunity methodology allows employees to be prioritized for engagement based on their perceived overall opportunity for better outcomes and savings instead of historical approaches focused primarily on clinical hierarchies.

Combining medical histories, personal communications, and lifestyle choices with health care systems, care management teams use this formula to help predict trends and identify employees with health risks. They reach out to provide information and support to help keep chronic conditions from escalating and monitor care effectiveness. The goal is more information available when employees need to make essential care choices.

For more information, reach out to Songer Benefits Inc., Located in Beckley, West Virginia, and serves all West Virginia and Virginia areas.