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Health Risk Assessments Could Jump 21% in 2007
12/12/2006
MyHealthGuide Source: AHC Newsletters, 12/7/06, www.ahcpub.com and www.watsonwyatt.com
The number of U.S. employers offering Health Risk Assessments (HRAs) is projected to jump 21% in 2007 according to international consultant Watson Wyatt Worldwide. Watson Wyatt's National Business Group on Health recently reported findings of a 2006 survey on employer-sponsored benefits, which reveals that two thirds of employers in the United States are already offering employees HRAs.
"Employers are trying to address the root causes driving the costs of health benefits, and employee health is a big part of that," says Watson Wyatt senior consultant Bruce Kelley.
Employers considering HRAs notice early on that using the assessments in helping employees avoid serious health compromises later on requires spending money now on administering the HRAs and paying for the incentives necessary to get the best level of participation possible.
"To get good participating levels, employees offer incentives, that initially are something like a gift certificate to every employee who completes the health risk assessment [questionnaire]," says Kelley. "As time goes on they need to offer a more substantial incentive, and often it is in the form of creating a difference in what employees contribute to their health plan. If they complete the assessment, their contribution into their health plan is reduced."
HRAs Help Employees Make Coverage Choices
"As employees pick up more responsibility for funding health care and other benefits, open enrollment is the perfect time for workers to evaluate their benefits and ensure that they select the coverage that is right for them and their families," according to Tom Billet, a senior consultant with Watson Wyatt. As for what workers can expect in the coming year, Watson Wyatt's survey and research higher premiums, deductibles, and co-payments for medical and prescription drug benefits are on the horizon.
Curbing those costs for themselves and their employees is behind the push to include HRAs, Kelley says.
HRA ROI: '2 to 3 Times'
As for the costs incurred by employers who introduce HRAs into their benefits offerings, Kelley says the payoff can be huge.
"Employers who offer health risk assessments and then follow up with prevention programs can save two to three times what it costs them [to pay for the HRAs]," he says. "After all, the costs they're avoiding [for serious or chronic health problems that progress unchecked] are pretty big."
How the HRA is delivered determines much of the cost. A web-based questionnaire is quite inexpensive, while a paper-based assessment that is accompanied by lab work is more expensive — but still cost-effective, Kelley says.
About Watson Wyatt
Watson Wyatt is the trusted business partner to the world’s leading organizations on people and financial issues. The Group and Health Care Consulting stands as the trusted business partner to organizations seeking fresh, evidence-based solutions to control health care costs and improve employee health and productivity. Based on data, technology and a total rewards perspective, we've developed a comprehensive set of services to help our clients in today's transforming health care environment. Watson Wyatt helps employers segment their covered populations into three cost/risk categories and design interventions for each segment to control costs, create plan efficiencies and change employee behavior. Visit www.watsonwyatt.com.
Free Clinics Prompt Better Health for Rutherford County Tennessee Employees
12/12/2006
MyHealthGuide Source: Nashville Medical News, 12/2006, Article
Editor's Note: The onsite medical clinic firm, CareHere, LLC, is closely associated with MyHealthGuide, the publisher of this Newsletter. Italicized comments below provided by editor.
"About three years ago, one of the consultants [Bob Shupe, President of ESP, Inc.] we were using in Rutherford County suggested that we consider an onsite medical program. We did a lot of research on it and found that it had some benefit to it. We went through the committee process, got it approved and kicked that off back in December 2003," recalled Jeff Craig, Rutherford County human resources director.
Contracting with Brentwood-based CareHere LLC, Rutherford County sponsors four clinics in county buildings where employees receive free medical care from a physician and free generic prescriptions.
“We’ve found that county employees love this benefit, and we frequently hear that this is the best benefit they’ve had in 30 years,” Craig said. “It’s been a tremendous success from an employee morale standpoint.”
CareHere specializes in onsite medical clinics and pharmacy management for organizations such as Rutherford County that self-fund their health plans. CareHere recruits the doctors and other medical professionals locally and provides online systems for appointment scheduling, electronic medical records, patient lab reporting and clinic inventory management. The company estimates that it coordinates more than 65,000 physician visits annually for its customers’ employees.
Waiting to see the Doctor is Virtually Gone
Craig said the clinics save employees time, and that means they see doctors more often. “I’m sure everyone’s familiar with waiting in a waiting room for an hour and 15 minutes, and then going back and waiting again in the exam room for 25 minutes — and then seeing the doctor for five minutes,” he said. At the county’s CareHere clinics, the wait is usually three or four minutes, he said.
“These are not walk-in clinics. You need an appointment, just like a doctor’s office,” Craig explained. “Yet, instead of double or triple booking, there’s only one person per timeslot, and they are 20-minute timeslots. Patients actually get the 20 minutes.”
Productivity Savings
Craig said most employees are back at their desk within an hour of leaving to see the doctor, which results in productivity savings. Also, the fee that Rutherford County pays CareHere is normally less than a physician fee in a conventional network. Craig acknowledged that it’s tough to pinpoint the county’s monetary savings “because we’re preventing things from happening,” things such as heart attacks or diabetes that would cost the system much more down the road.
“When you remove any kind of copay, when you remove the wait, you have pretty much removed all excuses for not going to the doctor. … Now our employees are going to the doctor and getting treated, and we think in the long run we’re going to prevent a lot of serious health concerns from ever happening,” he said.
The four CareHere clinics cost Rutherford County between $900,000 and $1 million annually, he estimated. [Since the onsite clinic program started, the County's health trust fund has grown several million dollars.]
Doctors Like the Concept
Craig said the physicians and other medical professionals at the clinics like the arrangement as well. “The doctors get the benefit of just coming in and practicing medicine and helping the patient and not worrying about filing insurance and getting their money back, because they’re paid a per diem rate,” he said.
Wellness Programs Integrated with Onsite Clinics
CareHere is one component of Rutherford County employees’ health benefits, which also include insurance and a health and wellness initiative called “Get RutherFIT.” CareHere foots the bill for the county’s part-time health and wellness coordinator.
Employees participating in Get RutherFIT receive a card which is stamped each time they get involved in a fitness or wellness activity. The county sponsors monthly Wellness Wisdom sessions on topics such as cholesterol and acid reflux. Drawings for cash and prizes (usually sponsored by CareHere) reward participants who receive seven stamps on their card or take part in the free annual health-risk assessments, which include full-panel blood work. There are also prizes for employee spouses. All dependents, by the way, are eligible to be treated at the CareHere clinics.
Get RutherFIT, in conjunction with the Books from Birth Foundation, is sponsoring a 5K run and walk on Feb. 17, 2007, with the proceeds helping to fund the popular program that mails youngsters free books. Employees participating in the event get a stamp on their card — and a chance at being just a little bit healthier.
“We’re always trying to add to the wellness program to make it more exciting, more interesting, to get more people involved in it,” Craig said. “If people are healthier, they’ll feel better and they won’t go to the doctor as often. The health insurance plan will be stable, and we can continue to provide great healthcare benefits to our employees.”
Meritain Health Acquires CBSA PERFORMAX To Create Largest Privately Held TPA
12/12/2006
MyHealthGuide Source: Meritain Health, Inc., 12/5/06, www.meritain.com and www.cbsaperformax.com
Amherst, NY – Meritain Health, Inc., a leading provider of health plan management services and a division of health care services company Prodigy Health Group, has announced the acquisition of CBSA PERFORMAX. The acquisition doubles the size of Meritain Health, creating the nation’s largest privately held manager of health benefits plans. Financial terms of the transaction were not disclosed. Goldman, Sachs & Co. arranged financing for the transaction.
The combination of Meritain Health and CBSA PERFORMAX brings together two companies that are passionately dedicated to helping employers control the long-term cost of health care while providing superior customer service and flexibility.
The combined company will operate under the Meritain Health name and maintain CBSA PERFORMAX’s presence in Baltimore and Minneapolis, as well as its regional sales and service offices. In total, the combined company has offices throughout the country, over 1,350 employees, 1,400 clients and over a million members nationally.
Industry Consolidation
The announcement reflects the considerable consolidation underway in the healthcare services industry. It follows Meritain Health’s August 2006 acquisition of Weyco, Inc., a third party medical benefits administrator, as well as the merger between Corporate Benefit Services of America (CBSA) and PERFORMAX, also in August 2006.
Elliot Cooperstone, CEO of Prodigy Health, said, “This acquisition is an important step as Meritain Health pursues its continuing strategy of controlled expansion through acquisition and the delivery of innovative products and services. Meritain Health and CBSA PERFORMAX each have a terrific history of providing intimate, local service while building capabilities on a national scale to ensure our clients have access to the most compelling products and services available. Together we will build on that legacy.”
Jacob L. Canova, President and CEO of CBSA PERFORMAX, will become Chairman and CEO of Meritain Health. Mr. Canova said, “We are pleased to bring together the very talented management teams, employees, and value-added products and services of Meritain Health and CBSA PERFORMAX. Both of our companies are completely committed to helping our employees grow and succeed, and together we will continue to work tirelessly to reward our clients for their confidence in us.”
Meritain Health and CBSA PERFORMAX have had an excellent relationship for the past eight years, as Meritain Health has provided claims services for PERFORMAX clients. The combination strengthens both companies’ objective of offering mid-size employers comprehensive, fully integrated health benefit services, including the design of customized, flexible plans that incorporate advanced cost management strategies.
Mr. Cooperstone added, “Health care is a local issue and to be successful in today’s rapidly evolving health care environment, we need to be where our clients are. That’s why we’re committed to delivering our services via regional processing centers and locating our sales and service offices close to our clients. The combination of Meritain Health and CBSA PERFORMAX will benefit our clients by creating one of the most extensive footprints in our industry.”
Meritain Health also announced that Ian Gordon has been named President and Chief Operations Officer, and Steve Adamson has joined the company as Senior Vice President and General Manager of the Minneapolis office. Mr. Gordon was formerly Chief Operations Officer of Concentra Network Services, and Mr. Adamson most recently was Vice President-Enterprise Business Operations at USAA.
About Meritain Health
Meritain Health is the country’s largest independent provider of services for self-funded health plans. Meritain Health serves over 1,400 self-funded clients and over a million members nationally. The company provides plan administration, innovative wellness, medical management, disease management, network management, and cost management services. Meritain Health is also a pioneer and now the leading independent provider of Consumer Directed Health Plans. Meritain Health employs over 1,350 people, with headquarters in Amherst, NY and regional offices in 28 cities across the country. Visit www.meritain.com.
About Prodigy Health Group
Prodigy Health Group is a health services holding company. Prodigy Health Group operating companies provide benefits management, total health management, provider network services and insurance services to self-funded employers, managed care companies and insurers. Prodigy Health companies serve over 3.5 million members across all industry sectors and Prodigy Health Group is continuing to pursue an aggressive growth strategy through synergistic health services acquisitions and organic growth. Visit www.prodigyhealthgroup.com.
CMS Launches Online Tools To Help Medicare Beneficiaries Compare, Choose Prescription Drug Plans
10/16/2006
- Newsday
October 16, 2006
Federal officials say they are offering better coverage for seniors signing up for the 2007 prescription drug plan offered by Medicare, which last week posted online tools to help consumers find the plan they want. But advocates warn that Medicare Part D could be as confusing as it was last year.
The program, which in January began providing prescription drug coverage to seniors and those with disabilities, was heavily criticized for presenting a confusing array of choices, offering incorrect information and making it difficult to sign up. Pharmacists often had to contend with further glitches once consumers tried to fill prescriptions after Jan. 1.
But Medicare officials say next year should be better.
"In 2007 there will be more plans ... more drugs covered and more help from Medicare ...," U.S. Health and Human Services Secretary Mike Leavitt said in a statement.
Medicare Part D enrollment for 2007 begins Nov. 15 through Dec. 31. In New York, 61 drug plans are being offered - up from 46 last year. The average monthly premium is $24, about the same as this year. If seniors are happy with their plan they don't have to do anything, Medicare said.
Last year, more than 10 million seniors nationwide signed up for a Medicare Part D plan; another 6 million dual eligibles - those who were on Medicare and Medicaid - were automatically enrolled in a Part D plan. An additional 250,000 have become eligible this year.
A gap in coverage - widely known as the doughnut hole - is also changing, but not going away. This year, once yearly drug costs exceed $2,250 in many plans, seniors have to pay the full cost of covered drugs until the total drug costs reaches $5,100. Next year, the gap is reached at $2,400 up to $5,451.25. In 2007, 17 of the 61 plans cover the gap, up from six plans that offer coverage this year in the doughnut hole.
The online plan finder, which was made available at www.medicare.gov Friday, has also been made easier to navigate and compare plans, Medicare said.
Despite reassurances from the government that seniors can stay with their current plan if satisfied, Deane Beebe, spokeswoman for the Manhattan-based Medicare Rights Center, said consumers should check their plans regarding costs and coverages.
"Assume nothing," she said.
She cited a Humana plan that last year cost $47.93 and this year will cost $82.10. Last year, the plan covered all drugs in the gap, but this year it only offers generic drugs in the doughnut hole, she said.
She also pointed out that in New York, of the 17 plans that cover prescription drugs in the gap, 15 offer only generic drugs; the other two cover generics and "preferred brands," those brands that the plan has chosen to include.
Jeanne Finberg, directing attorney for the National Senior Citizens Law Center in Oakland, Calif., said she is worried that seniors will again be faced with too many choices to make in too little time.
"This is crazy. It's just impossible for anyone who isn't a health policy computer wonk to study these plans and make a meaningful choice," she said.
And she fears dual eligibles will be vulnerable. They can be automatically switched out of their current plan into another plan if the plan charges more than the government's low-income subsidy premium, which is $24.45 in New York State. Often the sickest and the frailest, they are the group least able to get the information they need to ensure their drugs are covered, she said.
Meanwhile, pharmacists are bracing for the New Year.
"I believe it will be less chaotic than last January but this past January was like no other in my life," said Selig Corman, director of professional affairs for the Pharmacists Society of the State of New York.
For more information, call 1-800-MEDICARE or go to www.medicare.gov.
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