9Insurance Business ReviewJULY 20241. Eighty Percent Engagement in Preventive CareThe reality is that most employers do not track what percentage of plan participants use their preventive visits. These benefits are available at no cost to plan participants as a result of the Affordable Care Act, but most employees never take advantage of them. By promoting and incentivizing annual physicals for employees, health issues are detected at an early stage, which can prevent future chronic illnesses and additional high-cost claimants.1. Seventy Percent of Chronic Illness Patients Hold the Line or ImproveChronic illness patients typically account for 4 to 8 percent of the employee population. However, they usually account for more than 50 percent of the company's annual claims expense. In short order, they are a health plan killer. Creating programs to manage and control costs for those with chronic illness is critical. These programs may include onsite or near-site direct primary care, free maintenance medication such as insulin or blood pressure medicine, and free access to healthcare advocates to improve care compliance. These tactics reduce barriers to care and will help stabilize what your company is spending on high-cost claimants.By using the above tactics, employers can reduce costs and bring long-term stability to their health plan costs. Rather than the industry's typical 7 percent annual trend increase, these high performing health plan costs increase at a rate of only 1.25 percent per year. That same company with 500 employees will save $1.9 million dollars in a five year timeframe. That is cash that can be freed up for wage increases, used for capital expenditures, or held as retained earnings.Additional factors that are important to consider include compliance and employee communication. When implementing new programs, it is crucial to ensure they are compliant. Adding cost control tactics such as plan incentives or free maintenance medications can create new parameters when it comes to HIPAA, anti-discrimination laws, and data security. Be sure to have programs routinely reviewed by compliance officers and legal counsel.Employee communication is critical because people are just plain busy. Employees do not wake up thinking, how can I avoid a chronic illness today? A common oversight I see is communicating benefit program details solely during open enrollment and not throughout the year. Employers need to over-communicate benefits programs, perks, and incentives to their employees and dependents throughout the year to ensure higher levels of engagement.By creating an employee benefits strategy that promotes at least 80 percent of plan participants engaging in preventive benefits and 70 percent or more with chronic illnesses holding the line or improving, employers can control their long-term healthcare spend. In addition, organizations will free up capital to deploy in other parts of the business while improving employee retention. When it comes to this strategy, the well-known saying holds true: it's simple, but not easy. Programs can require an annual investment, additional compliance support, and other considerations. This makes it essential to have a benefits advisor who understands the nuances of successfully implementing a high-performance health plan. It takes a concerted effort, but the rewards are tremendous. Rather than the industry's typical 7 percent annual trend increase, these high-performing health plan costs increase at a rate of only 1.25 percent per year
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