How to Increase Your ROI on Preventive Services, Just in Time for Healthcare Reform

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The healthcare reform legislation enacted this past spring, known as the 2010 Patient Protection and Affordable Care Act, requires new employer-sponsored health plans to fully cover employee preventive care services, with no out-of-pocket costs for workers. The coverage extends to all Level A and B services recommended by the U.S.


Preventive Services Task Force, including cholesterol and blood sugar screenings, certain cancer screenings (such as mammograms and colonoscopies), as well as physician counseling for health issues such as obesity and tobacco cessation. As such, employees who previously may have had to pay a $10 or $20 co-payment for these services will now obtain them for free.


The enactment of this legislation couldn't have come at a better time. Americans are paying a heavy price for poor health choices and consequent health conditions that are preventable. Chronic conditions such as diabetes, heart disease, obesity and cancer not only contribute to a poorer quality of life, but are exacting a huge toll on our businesses and economy.


Approximately 75 percent of today's healthcare costs stem from preventable illnesses and chronic conditions, according to the Department of Health and Human Services. Improving access to preventive care will result in earlier detection of potentially serious conditions, thus reducing chronic illness, hospitalizations, dependence on ongoing medications and emergency room visits, while enhancing quality of life.  


For employers, the potential benefits of moving in this direction will include stabilized health insurance premiums and health costs, reduced employee absenteeism and presenteeism, and increased productivity. In a perfect world, all of the pieces would fall neatly into place and the Affordable Care Act would be a "win, win" for everyone. But, as with most things in life, it's not that simple.


To suggest that cost is the only barrier standing between employees and healthcare engagement - and that health plan members will now flock to their physicians for all manner of annual checkups -- is wishful thinking, at best. Over the last decade, many employer groups and health plans have experimented with free preventive services.


In fact, a 2009 survey by the National Business Group on health showed that 73% of large companies surveyed were already offering full coverage for preventive services, with many also offering free or reduced costs for mammographys, colonoscopies and other preventive procedures. Yet, despite these efforts and the willingness from employers to foot-the-bill, most workforces continued to see a low level of employee participation.  


So much so that a 2010 survey by the National Business Group on Health reported that employers believe low levels of employee engagement are the No. 1 obstacle to improving employee health and reducing health costs.


The message is clear. Unless businesses and health plans are able to engage employees and members in preventive health programs in greater numbers, health care reform, wellness initiatives and the many other efforts at healthcare cost containment may be little more than futile exercises.

Employee Engagement: Lessons Learned

Employers and health plans have been challenged by employee engagement since the 1970s, but the skyrocketing health costs and insurance premiums of the last decade caused many to redouble their focus to find new and more effective methods for increasing participation. One of the most important lessons learned was that there is no "one size fits all" solution to member health and wellness engagement.


From that lesson sprang a bumper crop of new wellness strategies designed to meet the needs and engage the interests of a wide range of members. From spirited team health challenges to individual employee coaching to on-site health providers and sophisticated Internet health management tools, employees have been bombarded with opportunities to get healthy and get happy.


Despite their many bells and whistles, most of these strategies have continued to produce a predictable result - they have primarily attracted the healthiest segments of the employee population, which, by and large, are already self motivated and inspired to stay healthy.


To everyone's frustration, the least healthy employees - those who are overweight or smoke or don't participate in a regular exercise program -- have remained unengaged, unmotivated and unchanged.In truth, there have been silver linings in health engagement strategies.


For example, companies who have developed and implemented financial incentives with their wellness programs report significantly higher participation in certain behavior management and health improvement programs. According to the NBGH survey, financial incentives ranging from as little as $51 to $100 can boost participation in smoking cessation and weight management programs and encourage workers to get biometric screenings.


But, participation in health risk appraisals is reported to require increased incentives, generally in the range of $100 or more. With many companies today facing shrinking margins and budget limitations, continuation of financial rewards may be difficult. The challenge companies how face is how to incorporate low cost strategies that replace or work effectively in tandem with financial rewards.


Another solution that is gaining some traction but is considered controversial in most circles concerns a health mandate. Companies utilizing health mandates for preventive care can require workers to obtain specific preventive screenings, such as physicals, blood-pressure and blood-sugar tests, Pap smears, and mammograms over a specified period of time.


Those who don't comply within the time frame, and for years going forward, can be required to pay a higher premium. Some benefits consultants say mandated benefits and other punitive health management programs are part of a growing trend. In a 2009 survey by Towers, Perrin, Forster & Crosby Inc., 45 percent of companies said they planned to, or were considering, adding penalties for employees who didn't participate in wellness activities.


But there are several huge concerns with mandated benefits. Labor leaders object to the idea of mandated health programs, and employers worry about the potential legal fallout. Some companies also worry that mandated health testing smacks too much of "Big Brother" and could damage the company image. For all these reasons, plus little hard-core evidence of the effectiveness of this approach, few groups care to walk this slippery slope.


For the most part, employers prefer to use a carrot, not a stick, when it comes to health benefits. Still, employers fret that their ever-growing menu of health improvement programs and options devised to tantalize every type of personality is not resonating with everyone. Why isn't it working, and how do groups solve it?

What We Have Here is a Failure to Communicate

Despite what may seem like an avalanche of employee communications about health in the form of emails, onsite posters, web sites and health events, many employees are simply tuned out, under-educated, ambivalent or overwhelmed by the healthcare maze. According to a recent study by the Midwest Business Group, a Chicago-based national coalition that represents many of the nation's largest and most well-known employers, 56 percent of employees surveyed said they have "no motivation to stay healthy."  


Even more telling, 88 percent of workers said they "lacked an understanding of the value of preventive services." They do not know what preventive screenings they need, when they need them, where to get them, how much it will cost them, or why they should bother to get them in the first place. Clearly, what we have here is a failure to communicate.


Employers and health plans have failed to connect the dots illustrating to employees how regular preventive screenings can detect health risks and conditions early, before they become lifetime chronic illnesses, like diabetes, or costly emergency health events like heart attacks or strokes.


In addition, employers and health plans have failed to address deeper concerns, such as fear about what preventive screenings may find, anxieties about the types of testing that will be done, and feelings of shame or embarrassment associated with certain types of screenings.


Another critical area that has not been adequately addressed in most health engagement strategies concerns time constraints and work-life balance. Many employees are overwhelmed both at work and at home, believing that they don't have the luxury of carving out the two, three or four hours that might be required to visit a doctor's office and get a checkup.

New Trends: Health Engagement 2.0

Though it may seem ironic, technology may ultimately be the solution that provides many members with the most personal and most relevant health engagement experience yet. That's because the newest technology platforms allow businesses to collect and mine thousands of bits of real-time individual medical data, such as claims data, lab results, prescription purchases, health risk appraisals and health plan coverage, and then merge that data with the individual's family, life-stage and behavioral attributes.


Such "data profiles" can not only help to reveal current and potential health risks, but can help to predict future health behaviors and barriers to health engagement. These analytics can be merged with time-tested consumer and behavioral science applications to develop the types of highly personal and individualized communications that engage, educate and motivate employees to participate in preventive programs in a timely manner.  


This new approach, which has already shown remarkable results, is called "personal health messaging." Personal health messaging and reminders can be delivered via direct mail to the home, email, telephone outreach or text messaging. On a very basic level, these messages inform employees of what screenings they need, when they need to have them completed, how to schedule an appointment, and what the cost will be.


On a deeper level, messaging can be devised that addresses the member's specific fears about the screening, can educate them about the screening, or can address scheduling, transportation or other concerns. They can even provide a sticky note reminder that members can affix to their appointment books or calendars!


Most important they are personalized and customized - pressing the "hot buttons" of each individual in ways that motivate them to take action and understand why it is in their best interest to do so. Engagement communications can be used for early intervention, health improvement or disease management to get the right message to the member at the right time to produce the right result.

How New Engagement Technologies Increase ROI

New health engagement technologies are already highly valued by early adopters for four reasons:

  1. Achieve Health Engagement Increases of 14-19 Percent: Early studies of new health engagement technologies that utilize personalized messaging have found that they can increase employee adherence between 14 to 19 percent in the first year alone. For example, in a 2009 study funded by the Cancer Research Center, a reminder program aimed at early screening for breast cancer boosted mammography rates by more than 17 percentage points, according to results published in the American Journal of Preventive Medicine. The program used electronic health records to identify women who would soon be due for a mammogram and reached out to them via postcards, automated voice messages and personal phone calls. In early studies at Evive Health, employers also have achieved average employee engagement increases of around 17 percent. The program engages 100 percent of employees, with an opt out rate of less than of 1 percent.
  2. Low Costs of Implementation: New engagement technologies cost just pennies on the dollar to implement and require no investment in technology, infrastructure or time. The most cost-effective programs of this type offer per member per month subscription options and include automatic upgrades to the system as new versions are released. ROI results can vary widely, depending on actual ability of the vendor to measure increased avoidance or early detection of costly conditions. In most cases, reported ROI ranges from $1.22:$1 to $4.3:$1, depending on the methodology and time period. A credible preventive analysis must include the cost that self insured employers pay for significantly increased utilization of tests and screenings.
  3. Easy to Integrate with Existing Preventive Care, Wellness and DM Plans: Technology platforms are easy to integrate with existing health and wellness programs and utilize flexible and customizable technology platforms that offer continuous comparison testing of messaging campaigns, with the goal of continually increasing engagement. The best programs offer the ability to offer coordination of messaging with clinicians and other providers.
  4. Measurable Outcomes

A key tenant of new technology platforms is the ability to provide timely reporting and measurable outcomes that support the value and performance of the engagement program. Such reporting allows for companies to adjust their messaging to achieve better returns on investment.


The field of personal health messaging promises to take employee health engagement to a new level - just in time for healthcare reform. When offered as part of a comprehensive health management program, these new turnkey solutions can offer employers a vital tool to shrink health costs, boost productivity and make everyone a winner.

About The Author

Peter Saravis is a co-founder and CEO of Evive Health, the leading innovator in designing personalized communication tools that motivate individuals to engage in health and wellness enhancement activities that improve their health, lower healthcare costs and lead to a happier and healthier lifestyle. Contact Peter at peter@evivehealth.com.