November 20, 2012

From The Plain Dealer
By Sarah Jane Tribble

“If you just get off the couch, you’ve made improvement. Not doing anything is the problem.” – Paula Sauer, Medical Mutual senior vice president of pharmacy and care management

CLEVELAND, Ohio — If your company provides your health insurance, keep this in mind: Your employer wants you to be healthy, and it's to your benefit as well.

Human resources firms and large health insurers such as Medical Mutual of Ohio and Aetna report that an increasing number of employers are tracking work-force health in an effort to offset climbing insurance costs.

Employers are asking their insurance companies to report whether their employees are controlling their blood pressure and their cholesterol. They are asking if employees are trying to quit smoking or lose weight. And they are paying attention to how well employees are managing their diabetes and if they are getting preventive care.

"It's all about the wellness programs, and the data analytics piece is really a critical bridge that has been missing," said Chuck Adamczyk, senior benefits consultant at Cleveland-based CBIZ, a national professional services firm that helps employers design health plans.

Adamczyk said that while insurers have long tried to promote wellness, they now have the data to track whether you are going to the doctor, showing up in the emergency room or taking your medicines.

Consider national insurer Aetna. The company's subsidiary Health Data Management & Solutions, or HDMS, keeps millions of patient files on computer servers in a nondescript warehouse on Cleveland's East Side. The rooms are climate-controlled with multiple backup generators to ensure that data won't be lost if the power goes out.

Employers that are Aetna customers have access to an online portal that's linked to the data inside these computers. There they can run reports that detail how many obese employees they insure. They can fine-tune the report to learn how many visits to the doctor their overweight employees have made and what other diseases, such as high blood pressure or bad cholesterol, they have.

Denise Zeman, a senior vice president and chief administrative officer for HDMS, said one of the most common reports employers request is on obesity. Another frequently requested report is on how often employees use expensive emergency services.

Employers can't retrieve specific names, but rather numbers: A report can tell an employer that 10 percent of its work force used the emergency room last year and how much that cost in dollars, Zeman said. A federal privacy law protects the names of individual employees.

"The end goal," she said, is for the employer to better understand their spending and figure out what health plan design is best for the work force.

Employee rewards and penalties rising

Towers Watson, a national benefits consulting firm, found that over half the employers answering its survey in the U.S. last year are using rewards for participation in health management programs -- and 80 percent of those surveyed planned to use them in 2012.

The report said that most employers in the U.S. and Canada believe in holding both managers and employees accountable for work-force health and productivity.

While financially penalizing workers who do not participate in work-force health management programs is not permitted in Canada, Towers Watson reported that the use of penalties more than doubled in the U.S. from 2009 to 2011 -- rising from 8 percent to 19 percent of employers. Thirty-eight percent of the survey's respondents said that by 2012 they would use financial penalties.

Paula Sauer, senior vice president of pharmacy and care management for Ohio's biggest health insurer, Medical Mutual, said many employers become frustrated when they see employees not taking care of themselves.

"They feel it's not appropriate to charge everybody the same," she said.

That's true in Ohio as well, said Lisa Kaiser, director of central market and programs for the Health Action Council. The organization, which is made up of large employers in Ohio, has many members who are already changing their workplace culture.

"It's going to be expected that when you go to a meeting you walk up and down the stairs," Kaiser said. "You'll have almonds and apples for snacks and no doughnuts. And the CEO is leading the fitness challenges."

It's a "shifting of everyone's perspective within the organization," Kaiser said.

In addition, most large employers are waiving co-payments and fees for preventive services, such as that annual physical, and for chronic-illness maintenance, such as diabetes medication, she said.

As a way of decreasing their costs and adding extra motivation for workers to stay healthy, many employers are turning to high-deductible health plans. Such plans generally cover preventive care but ask workers to pay a certain amount -- often $1,000 to $2,500 -- out of pocket before insurance coverage kicks in.

A new report by benefits consultant Mercer finds that 36 percent of large employers nationwide offered high-deductible health plans in 2012, up from 14 percent five years ago.

Enrollment in those plans has risen to 16 percent of all covered employees, compared with 5 percent in 2007, according to Mercer.

Be sure to take preventive measures

So, what's a worker faced with paying a higher share of his or her health care costs to do?

Medical Mutual's Sauer said that at the very least workers should keep up with their preventive health measures, and get some exercise.

Sauer said employees need to have annual checkups and make sure to get their mammograms, colonoscopies and Pap smears. Flu shots and annual childhood immunizations also are being encouraged.

Insurers are looking at who's doing so and then calling or sending a letter to those who haven't had that service, she said. In addition, workers need to watch their weight and work with their doctors to keep blood pressure and cholesterol under control, she said.

If employees don't take control of their health, said Adamczyk, they will pay the price in more ways than one.