Thinking about health insurance beyond the coverage

Laura Mertz, special for Lehigh Valley Business//July 11, 2019

Thinking about health insurance beyond the coverage

Laura Mertz, special for Lehigh Valley Business//July 11, 2019

On every employer’s wish list is affordable, reliable health insurance. The challenge is finding effective solutions as prices increase, without passing costs on to employees in the form of high deductibles. This may lead to a deficiency of health care for employees who cannot afford it and opt to forego care intervention. Ultimately, employee health problems affect work performance and contribute to higher costs.

Ideally, company leaders will need to think outside the box in order to find realistic solutions to impact employee health, high deductibles and premiums, and their bottom line. Addressing lifestyle risks and all aspects of employee well-being is key. Once employers make the shift in perception, emphasizing preventive care, lifestyle modifications, and the importance of behavioral health, it becomes evident that they can have a big influence on the health of their employees, and therefore, their own expenses. There are resources that employers can provide to educate and support employees with leading healthier lifestyles. Initiating one, or all three of the following, can be a first step toward a comprehensive plan to cultivate a healthier workforce.

Importance of primary care

When the right kind of health care is provided at the right place and time, health care is appropriately utilized across a population, and unnecessary treatments, medications and procedures are prevented. Take, for example, an employee who is diagnosed with high blood pressure. When he or she is treated early and appropriately, more serious chronic health conditions can be mitigated, such as heart disease and stroke. Certainly, high blood pressure is less costly to treat than chronic heart disease. Consider the long-term effects on health care quality and costs across your employee population when care is delivered the right way.

Research shows that health care outcomes and costs are greatly impacted by patient access and relationship with a primary care physician (PCP). An increase of one primary care doctor per 10,000 people has been shown to result in: a 5 percent decrease in outpatient visits, 5.5 percent decrease in inpatient admissions, 10.9 percent decrease in ER visits, and 7.2 percent decrease in surgeries. Furthermore, now that insurance companies are basing reimbursement on outcomes rather than volume of services performed, the PCP’s adherence to quality and accountability becomes a factor that can impact health care costs.

Raising health consciousness

Building morale is closely connected to employee wellness and to curbing expenses. When you have a workforce that is healthy and satisfied, employees care more about the job they’re doing and are more productive. Data shows that employees with health conditions and at high risk for health problems had productivity costs ranging from $15 to $1,601 more per year than similar employees without health conditions/risks. This means that an employer with 10,000 employees could face nearly $3.8 million in productivity loss each year, in addition to medical costs for these conditions.

In this vein, there are many options employers can implement to bring about a shift toward a healthier company culture. There are wellness programs, employee assistance programs (EAPs), fitness programs, and occupational health and safety options available to employers, including those in the Lehigh Valley. It’s important to also consider the supplemental elements: supporting work/life balance, offering healthy options in vending machines, or introducing health challenges and online wellness tools. As the consciousness of the workplace changes and employees get onboard, they feel more empowered, feel better about coming to work and are naturally more productive. Here’s what the Harvard Business Review reports:

“In studies by the Queens School of Business and by the Gallup Organization, disengaged workers had 37 percent higher absenteeism, 49 percent more accidents, and 60 percent more errors and defects. In organizations with low employee engagement scores, they experienced 18 percent lower productivity, 16 percent lower profitability, 37 percent lower job growth, and 65 percent lower share price over time. Importantly, businesses with highly engaged employees enjoyed 100 percent more job applications.”

Variety can add spice to life

Employers can make a difference in the area of insurance benefits as well. Each employee’s health needs are different, as are the ways in which they utilize their employer-sponsored health plan. For those reasons, some employers are offering more than one plan to their workforce. In fact, according to the Employer Health Benefits 2017 Annual Survey, 58 percent of covered workers are employed in a firm that offers multiple health-plan options.

While multiple plans may require some organization, variety allows employees to decide for themselves what coverage is right for them. It can also save employers money, if they opt for one selection as a lower-cost base plan with reduced premiums. Giving employees control over how their health benefits are structured can increase feelings of autonomy and satisfaction, also adding to their overall well-being. This flexibility, combined with a focus on health and PCP involvement, achieves an employer’s number one important business goal: To protect the most valuable asset they have – their employees.

Laura Mertz is associate executive director of Valley Preferred, the physician-led preferred provider organization aligned with Lehigh Valley Health Network. She also oversees the marketing, business development, and provider and payer services functions for Populytics Inc.