Healthcare costs have spiked a whopping 250 percent, accounting for 5.0 percent of U.S. Gross Domestic Product in 1960 and 17.5 percent in 2014, according to research jointly published by Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group; U.S. Department of Commerce, Bureau of Economic Analysis; and U.S. Bureau of the Census (pg. 6).
In this climate of runaway costs, self-insured companies lack the necessary analytical tools and data to target and control spending or anticipate future trends. In fact, many are blindly investing in programs they hope will improve outcomes and reduce claims. Yet the desire to get patients to better manage their own health remains strong. That’s why fully 72 percent of employers now offer programs and services to raise participants’ awareness of their health status and risks (pg. 8).
Given this growing trend, we’d like to share a few tips we’ve learned from the trenches on what’s needed to ensure wellness program success:
Select the right analytical tools:
An engine that creates a multi-point analysis, factoring in individual health status, behaviors and non-clinical attributes, and also covers a wide range of triggers and benchmarks to identify opportunities and risks in your population is critical.
It should also provide the ability to customize a health plan according to individualized reports which include behavior and non-clinical attributes, yielding an accurate risk-score for admission and readmission, regardless of company size.
Get employee buy-in:
Employee buy-in to a wellness program is key to success. Some 57 percent of employers (76 percent of large employers) offer disease management plans, but participation is low (e.g. 18 percent of diabetics participate, even though 75 percent of employers consider it either the most or second-most valuable patient cohort for disease management) (pg. 8).
Also, a good platform uses evidence-based medicine and behavioral economics to help employees make better decisions on their medications. It will be important to advocate for individuals to take more of a consumer-like approach to managing their health which can help lead to savings and better health outcomes
A grand majority (87 percent) of employers want to increase their employees’ awareness and effective decision-making on health issues (pg. 8)
To most effectively improve employee health and reduce costs, employers and providers must be able to help patients not only better understand their health but also realize savings when it comes to their healthcare expenses.
Access to digital healthcare tracking technology and devices make it easy for consumers to monitor their health vitals, including blood pressure, weight, glucose levels, activity levels and blood oxygen levels.
By incorporating the health vitals compiled from health tracking devices into a data analytics engine, employers are able to reduce employee health costs, improve health outcomes and empower individuals to be hands-on managers of their own health.
Commit to the program:
The ability to constantly monitor the impact of intervention and progress at the macro and granular levels to stay on track of ongoing clinician support and oversight for client organizations is key. Steps may include:
Review plan trends to stabilize costs and get the full benefit of expenditures in time, resources and talents.
Organize the population according to level of risk and design interventions to optimize member health and productivity across the care continuum from prevention/health promotion to chronic health conditions/behaviors and onto to individuals with high risk/utilization.
Survey and enhance the “local advantage” and provide data analytics to strengthen medical homes and other interdisciplinary efforts that optimize effective utilization for both the medical and pharmacy plans.
Analysts should remember to measure all results beyond the obvious savings in total cost from one year to the next. Often, this requires utilizing third-party software with powerful analysis capabilities to discover not only the savings accrued in every medical and pharmaceutical category, but the increased health of the entire population.
Despite the success and cutting-edge technologies, some employers remain skeptical of wellness program ROI potential. Admittedly, some platforms fail to make the wellness programs work, or even neutralize costs. Different factors, such as employer size, and a time path of 3 to 5 years for ROI impact is enough to discourage smaller employer companies from implementing a wellness program.
Unsurprisingly, employee participation in these programs is around 30 percent, and only 10 percent of employers who offer wellness programs measure ROI (pg. 8). For program success, employers and consultants need to make sure the right program is in place, with the right support and management tools capable of meeting the high-level information and data analysis needed. For an opportunity assessment, please click here.
But there is clear evidence that, if properly managed, wellness programs can have a big impact. According to an article published in “Health Affairs,” by Katherine Baicker, David Cutler and Zirui Song:
A Harvard University study of 100 peer-reviewed articles found that with a well designed and implemented program, costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent.