http://www.atlantatribune.com/id192.html
by Keith Laing, Atlanta Tribune: The Magazine
October 2007
More often than not, the debate about the rising cost of health care focuses on families. The picture is of Mom and Dad, struggling to balance the family budget while health care costs tip the scales.
It is a picture that is as true as it is overly simplistic. Everyday in Everywhere, USA, kitchen table conversations about the skyrocketing costs of health care are indeed taking place; however, most Americans get their insurance from their employer. That means businesses of 400 are feeling the crunch just as much as families of four.
For instance, the City of Atlanta provides insurance to roughly 8,000 employees, as well as another 4,500 retirees and relatives, according to Human Resources Commissioner Benita Ransom. Employees pay a premium of course, but the City covers 77 percent of the insurance costs.
And City employees are the lucky ones, Ransom says. City insurance plans include health and dental coverage, as well as optional vision and life protections.
“Medical costs are skyrocketing. There are over one million Georgians who don’t have insurance because a lot of companies don’t provide it because it’s too expensive.”
Those that do feel it in the wallet, Ransom adds. She says big employers like the City of Atlanta sometimes have self-funded health plans, making them responsible for claims filed by employees. That gives them a vested interest in keeping their employees as healthy as can be.
“Having a healthy workforce lowers costs,” she says. “When you don’t have a healthy workforce, it shows up in absenteeism and a lower quality of service.”
That’s why the City does everything it can to keep their employees out of the doctor’s office and at their work stations. Focusing on preventive care, the City collaborates with its insurance providers to sponsor workshops, give free screenings and distribute literature. Employees are given paid leave annually for physicals and to donate blood. The City also examines claims data to see which ailments need more attention.
“We try to highlight diseases that are prevalent among our employees,” says Ransom. “The major way we do that is looking at claims costs. We know where we are spending our money because we look at what claims have been filed over the five or ten years to see if we see any reduction across age, gender, employee, family, active or retiree. We pretty much know, not by name, but by [demographics] who’s going to the doctor for what, because one thing that’s very important is disease management.”
Often, employees who are not feeling symptoms go back to ‘business as usual’ after their first doctor visit, which can lead to further problems down the road, Ransom says. To combat that, the City’s insurance companies follow up with employees after doctor visits with calls and reading materials. The city also operates a gym that is open 24 hours a day, and free to all employees.
Other large Atlanta employers offer similar programs for their employees. For instance, Georgia State University offers access to a discounted Weight Watchers program and a ‘stop smoking’ program. The university also provides reduced-priced yoga and meditation classes, as well as regular lifestyle roundtable discussions.
When employers decide to trim the fat of their health care budget, they usually turn to people like Staycee Benjamin-Stone, a worksite wellness consultant for Kaiser-Permanente, one of the City’s insurance providers. Kaiser provides wellness programs for over 75 local companies.
It is Benjamin-Stone’s job to create specific wellness plans for clients, based on their needs. Bottom-line sensitive employers often prompt her first visit.
“Generally, when I go out to speak with a new group, they have had the discussion on saving money already,” she says. “The attitude is that with health costs going the way they are, we’re not going to be able to afford to support employees who choose negative behaviors.”
The workshops are all encompassing, targeting both those who are completely healthy and those who have conditions that are treatable. “Worksite wellness focuses on keeping healthy people healthy as long as possible and helping anyone with any kind of chronic disease to educate themselves and manage their condition effectively. If you get people earlier, they stay healthy longer,” Benjamin-Stone says.
In addition to focusing on specific conditions, Kaiser Permanente’s worksite wellness programs provide insights into common workplace challenges like managing stress and eating healthy at work, Benjamin-Stone says.
There is also a heavy focus on regular physicals and examinations.
“We want people to have annual physicals because certain conditions don’t have bells and whistles,” she says.
Still, the benefits of the programs are not always immediately visible, but they are there. “We know when people are able to be supported to change unhealthy behaviors, we see a demonstrable difference. Sometimes it takes a long time for people to change though. It all depends on where they are on the health continuum,” Benjamin-Stone says.
With that insight, Benjamin-Stone is prompted to promote the benefits of worksite wellness.
“When you demonstrate to employees that you care about them, that [their] health is important to us, not just to our bottom line, you increase morale,” she says. “When people are supported, you reduce absenteeism and presenteeism. You want healthy employees because they have more energy and think more clearly.”
Providing support is especially important in the modern workforce, where the workdays and time off are blurred by teleconferencing and take home projects.
“The American lifestyle is one in which we overwork ourselves,” she contends. “We’re doing more with less time and that has an impact on our health. People used to work 9 to 5 and have an hour lunch, but now you have to work 9-6 to have an hour off. Then, in a place like Atlanta, traffic is so bad that our commute times are longer, so our days are longer with less time to ourselves.
“Our requirements are high,” Benjamin-Stone continues. “We demand a lot from people, so we need to support that with self-care. People are going to be productive if they take care of themselves.”
Kaiser-Permanente is not alone in that belief. Other insurance providers, like Aflac, also offer wellness maintenance programs. Several Aflac insurance policies include free preventative medical testing and screenings such as annual physicals, mammograms, pap smears, eye examinations, ultrasounds and blood screenings.
Another less conventional way that some are opting to stay healthy and gainfully employed is by utilizing health savings accounts. Under traditional health savings accounts, the employer is the primary insurance client, arranging coverage for its workforce. However, with health savings accounts, individuals conduct that business themselves for themselves and their families.
HSA holders make deposits into specifically marked bank accounts that can only be withdrawn for medical purposes. However, unlike traditional insurance plans, where claim agents decide what is and what is not an appropriate medical expense, HSA patients answer only to themselves.
Proponents argue that giving individuals a financial stake in their health care encourages them to make rationalization choices in their behavior and treatment seeking, much in the way individuals comparison shop for houses and cars. In those markets, sometimes people forgo the things they love for the things they can afford.
However, HSA opponents say medical decisions are anything but rational, and also too complicated for untrained eyes to be making what could become life and death decisions. They fear the notion of people forgoing treatments they need to keep their cash in the bank.
Steve Gerst, CEO of Plan Service Providers, a leading HSA facilitator, acknowledges that traditionalists do exist, but says health savings accounts are the wave of the health care future. He also argues that critics’ perception of the program as benefiting only the highest end of the tax bracket are unfounded.
“It’s a new way to practice medicine, but it’s better for the doctors and better for the patients,” he says. “Some people think HSAs are a healthy and wealthy type of program, but most of our buyers are people who can’t go to the emergency room. What happens if you have hourly workers who can’t afford to take time off from work? Our doctor’s make house calls.”
Gerst says that among health savings account holders in Georgia, emergency room visits have decreased as much as 80 percent.
“The way its designed is that everybody has a financial incentive to work together to keep people healthy,” he explains. “The incentive is not only for the health and wellness of the population, but because the money is going into the banks. Banks want to keep people healthy because as long as the money in the bank, they can lend it out for mortgages.”
Health savings accounts tend to change the nature of the doctor patient relationship.
“They immediately go to the doctor and say ‘I need you as a consultant. Tell me what I’m doing wrong. How do I stop smoking? How do I lose weight?,’ Gerst says. “They are going to the doctor for wellness instead of sickness.”
That’s why HSA providers measure success in terms of dollars saved instead of dollars spent. Even when HSA customers do seek treatment, they are encouraged to seek doctor visits or utilize clinics, according to Gerst.
“When you have medics and clinics, you don’t need to go to the ER at seven times the cost and people get what they need cheaper and quicker, which is always at a premium,” he says.
Whether using traditional insurance, health savings accounts or preventive measures, it’s clear that staying healthy is now a part of everyone’s job description. For both employees and employers, the bottom line depends on it.
