New consumer-centric approach seeks more aggressive alignment of employer, employee and trusted clinician interests
It's easy for employers to pick low-hanging fruit from the proverbial money-saving tree by implementing cost shifting strategies and doing whatever they can to reduce vendor costs. But this fixation is terribly myopic and no longer suitable for a more demanding post-health care reform marketplace.
The clearest path to removing businesses from the shackles of double-digit cost increases and rising medical inflation is to embrace a more methodical, long-term strategy built on evidence-based clinical insight and scorecard-driven programs over at least a three-year period that place employer, employee and provider actions onto a convergent path to success.
The notion of this vision, which no doubt will deliver a greater return on investment in human capital, is to harness the power of a model that more aggressively aligns the interests of employers, employees and providers through a workplace "culture of health" that once and for all seeks to end a system of operational silos among these three groups.
Serving as a foundation for change are a veritable alphabet soup of new tools that include an Employer Health Opportunity Assessment (EHOA), Individual Health Opportunity Assessment (IHOA), and Community Provider Opportunity Assessment (CPOA). Health plan management has evolved from traditional case management and disease management programs to the use of more sophisticated strategies involving population health, as well as employee work life health, engagement and achievement on the job efforts.
But the next generation of programs will not only foster a culture of health, but also improve community wellness as a tangible advantage in the group health benefits market. This ambitious objective is achieved when an employee population collectively makes the right choices with regard to lifestyle, health and wellness resulting from a convergence of interests and support systems, structures and processes.
It becomes a self-perpetuating competitive advantage by "bending" the cost curve while also improving the health and productivity of covered lives without reducing benefits or cost shifting to their employees.
Strategic roadmap to Population Health
Employers that benchmark their respective cultures of health adopt five key elements that include developing integrated multi-year strategic roadmaps for improving the wellbeing of their workforces; expanding their sickcare focus to integrated population health management; and educating, tracking and rewarding all covered lives for becoming "smarter consumers" of care.
These objectives are achieved by working directly with the most relevant community providers to better care for their covered lives and empowering a dedicated physician executive to assist in program design, implementation and vendor management. At the heart of this approach are the aforementioned three assessment tools, which enable business leaders to get a much better handle on their employee health care costs.
An EHOA is the most comprehensive evaluation tool for assessing and tracking the pursuit of a culture of health, objectively measuring progress on more than 250 elements across an 11-point scale that's weighted by five thresholds of program effectiveness and efficiency. This assessment features interviews with anywhere from 10 to 30 key staffers who work in HR, benefits and finance.
In a nutshell, it seeks to identify and establish the relative value of elements for prioritizing the most impactful steps to help benchmark performance, as well as develop multi-year plans and budgets. Health plan reports also are reviewed to spot key trends and gauge vendor performance. Another application involves uncovering anomalies. For example, one employer client's prescription drug formulary and inferior disability benefits coverage created barriers to rehabilitation and slowed returns to work.
From the health care consumer's perspective, an IHOA offers employees and their spouses a face-to-face annual assessment and clinical consultation with a trusted physician and employee assistance program specialist for a more holistic view of their situation. This tool tracks process indicators that include the extent to which employees are participating in health-risk appraisals, biometric screenings and health fairs.
In addition, a series of educational programs are designed to reward employees for being smarter health care consumers. One way to describe the IHOA is that it's like a health-risk appraisal on steroids in the sense that once all the necessary forms are filled out, employees meet with a host of clinicians that include a phlebotomist, nutritionist, physician and psychologist to review their personal health profile and make recommendations.
This team approach isn't intended to interfere with an employee's existing medical care; rather, it seeks to motivate more people to align themselves with a primary care physician and/or embrace a more aggressive ongoing treatment regimen. The final piece of the puzzle involves a CPOA, which identifies key practice parameters that affect culture-of-health capabilities - creating a baseline against which progress can be measured.
Under this model, which provides regular feedback and pays performance incentives, the idea is for selected community providers to promote health center support systems and meaningful tools, including electronic medical records and evidence-based search engines. A CPOA scorecard incorporates medical-home standards under the National Committee for Quality Assurance umbrella, as well as employer-alignment standards.
The CPOA works particularly well for organizations with a high concentration of employees in a relatively few number of Zip codes. Assembling a team of physician executives with deep experience who are used in a consultative role is akin to having a chief medical officer on staff, which research shows can help lower employee health care costs - even though this position has been created for only about 20% of the Fortune 500.
Employers that use these assessment tools along the way to building a culture of health will realize a greater potential to improve employee health outcomes, which, in turn will result in more effective cost-containment. For example, Daiichi Sankyo, Inc., known for its ingenuity edge in the global market, recently launched a culture-of health program and determined through the EHOA process that the best way to realize the total economic value of health, well-being and optimal employee engagement is to execute a three-pronged healthy achievement strategy featuring a competitive benefits package, employee accountability and health-risk management.
Within each workplace, it's imperative to not only have the CEO and line management driving these initiatives but also identify passionate staffers - gym rats, weekend warriors, ex-smokers or people who've lost a considerable amount of weight and are willing to act as champions for health care and, in turn, elevate the level of employee buy in.
Word of mouth is the most powerful advertisement of all, and if enough of these employees can shout their inspirational stories from the rooftop, then it will vastly improve the chance that colleagues will follow their lead. But it's not enough to extol the virtues of wellness. Employers also need to devote enough resources to ensure programs are actually being implemented.
About The Authors
Les C. Meyer, MBA, a seasoned health care strategist and chairman, Informed Opinion Leadership Action Group (IOLAG), vice president of HealthNEXT, senior fellow, Jefferson School of Population Health, Thomas Jefferson University and board member Patient Advocacy Institute, can be reached at (303) 916-0017 or Les.Meyer@HealthAndPerformance.info. David Kirshenbaum, chief operating officer of HealthNEXT, can be reached at 860-305-2907 or dakirsh@weaconsult.com.
