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From the Trust Perspective: Does wellness matter? 

by: Bob Haynes, Associate Director for Risk Management Services 

The Health Benefits Trust, administered by your League, has put a strong emphasis on wellness for the past 20 years -- when we hired our first wellness coordinator. This emphasis remains as we consider new ways to incentivize employees to adopt positive behavior change when it comes to managing their health. We all know healthier employees are happier, more productive and have fewer medical claims.

Over the past three years we have seen a spike in claims above $50,000 within the Trust. These costs could be from premature babies, cancer treatments, accidents and in some cases poor health habits. We typically average fewer than 100 large claims. However, this number has grown as high as 160 in 2013. Through three quarters of 2014, there are 96 members with more than $50,000 in cost, compared to 132 members at this point last year. This number represents only 1.1% of the members, but 30% of the cost. While we are pleased with the trend downward for this year and are seeing a decrease of 27.5% decrease in costs, these numbers are still higher than historical averages. Overall costs through the third quarter are down 5.3% (all claimants, not just high cost claimants).

One way to influence behavior is to require employees to get their wellness exams, which include an annual physical and age appropriate cancer screenings. These exams are offered at no cost (deductible or copay) to the employee or their covered dependents. The Trust has done that this year by implementing a program where a 10 percent surcharge will be applied should an employee not have their annual physical, age appropriate cancer screening or participate in the “Personal Care Management” program offered by our administrator, Medcost Benefit Services. We believe that early detection and treatment of high blood pressure, pre-diabetes (type II), high cholesterol, etc. will save dollars as we prevent catastrophic events.

The statistics through October of this year of how many in our program that meet the eligibility criteria, but don’t take advantage of the free screenings, are surprising:

  • Mammogram: 720 out of 1,829 members are non-compliant (39%)
  • Colonoscopy: 1,497 out of 2,830 members are non-compliant (53%)
  • Annual physical: 2,459 out of 5,949 members are non-compliant (41%)
  • Pap: 847 out of 2,191 are non-compliant (38%)

These numbers are actually better than from a year ago since we announced the 10 percent penalty this spring.

In addition, we are developing programs that will enable our members to easily access vendors that will come onsite to conduct screenings and fulfill the annual physical requirement from their employees. Additionally, these vendors will be able to provide support in the development of worksite wellness programs. Examples might include employee education on eating healthy while on the go, cooking to reduce fat and sugar in the diet and creative ways to improve exercise habits.

Finally, our wellness grant program is being assessed with the goal of providing effective ongoing wellness program support. Onsite biometric assessments that will help identify potential medical issues can already be covered through the program as a wellness claim.

Assisting us in these plans is a focus group comprised of the participants in the Trust. They are providing creative and practical ideas for the staff to consider and develop.

Please let us know your ideas on how we can we can improve our current wellness program offerings, or create new and effective programs.