Traditional Health Plans Begin to Adopt Elements of Consumer-driven Approach
The lines between traditional health care insurance products and consumer-driven health plans are beginning to blur as insurers look to include consumerist elements in all product lines.
HMO, PPO and POS offerings are all being modified to incorporate features typically associated with consumer-driven health plan products.
The changes follow significant moves into the consumer-driven health plan market by large insurers.
In the past year, the two largest managed care insurers--UnitedHealth Group and WellPoint--have bought, respectively, Definity Health and Lumenos. Other major insurers such as Aetna have aggressively developed their own consumer-driven health divisions.
For more on this article, click on Consumer Driven Approach
Expert Offers How-to's On Saving Health Care Costs for employers
Mark Roman, head health-care guru for Electronic Data Systems,the Dallas-based IT giant, has a number of suggestions for employers struggling to control escalating health-care costs, many of them especially relevant here in the high-cost Bay Area.
Per the San Francisco Business Times, the following are Roman's money-saving recommendations:
Educate employees by providing access to health-care information and educational programs, such as web-based consumer tools.
Offer workers incentives to make crucial lifestyle changes, such as stopping smoking and losing weight. A handful of major disease categories contribute to the bulk of all health-care costs, and many are preventable. Tailoring co-pays and deductibles also can reinforce cost-effective -- and healthy -- choices.
Make health an important part of the company's corporate culture. Provide health-related activities such as on-site health screenings, discounted gym memberships and company-sponsored fitness events.
Combat obesity-related health-care costs by providing healthy food choices in vending machines and company cafeterias and at company events.
Provide care-management or disease-management programs for employees with costly or chronic diseases. These programs -- either online or offered through local health-care providers -- can help participants learn to better manage their health.
Consider consumer-directed health plans, "a powerful new strategy" to reduce employers' health-care costs. These plans offer workers a set amount of money to spend on health care throughout the year (typically paired with catastrophic coverage as well), and "empower them to take control of their own health."
Consider benefits-management outsourcing, which allows a company to focus on its core business by outsourcing H.R. functions such as benefits administration.
Demand more from insurance companies, and take an active role in evaluating doctors and hospitals to find those that offer the most effective care for costly diseases. Couple these efforts with partnerships with local hospitals, clinics and physicians to emphasize the importance of healthy lifestyle choices.
Health Savings Accounts: The New 'Medical IRA'
Sick of costly health insurance premiums? Tired of HMO restrictions? Then maybe an "HSA" is for you.
A health savings account, or HSA, is like an individual retirement account for medical care. You can contribute up to $2,650 for an individual and $5,250 for a family, and that nest egg can be invested to earn additional income.
For many, one attraction is the favored tax treatment HSAs offer, although proponents say they can also help to contain the rising costs of medical care by encouraging consumers to spend their dollars wisely.
"The money is tax-free going in, it accumulates tax-free, and when it comes out, as long as it is spent on qualifying [medical] expenses, it comes out tax-free," said Tom Billet, a senior benefits consultant in the Stamford, Conn., office of Watson Wyatt Worldwide, a benefits consulting firm.
Plus, HSA participants can deduct the entire amount of their annual contribution from their federal income taxes.
Click on HealthDayNews
for more information.
Small Employers Are Ready To Embrace HSA Plans, But Broker Involvement Is Critical
The nation's small-business owners — ravaged by years of double-digit rate hikes — could turn to HSA-based plans in droves in 2006.
But insurance agents and brokers — typically the only source of information for small employers — could hinder adoption rates if they fail to understand the fundamentals of HSA-based plans.
Some insurance agents — typically small businesses themselves — have turned to HSA-based plans for their own staff.
Once brokers and agents understand the benefits of HSAs through first-hand experience, they are more likely to promote them to their clients, Koch explains. "Employers aren't going to [understand] this on their own."
For more on this article, click on Consumer Directed Care
Accounts For Health Care Gain
A year and a half after the government made health savings accounts legal, HSAs are moving into the mainstream as more Americans seek affordable health care coverage.
For Jim and Lenore Bolig, early semi-retirees who moved to Myrtle Beach eight years ago, a health savings account helped them find a more affordable way to foot the bill for their own health insurance.
The Boligs were self-employed for many years, but had a company plan that covered themselves and their employees. Upon retirement, Jim Bolig started shopping around for a new plan.
"To me, this was the best value for the buck," Bolig said. Health savings accounts are interest-bearing savings plans paired with high-deductible health insurance plans that generally cost much less than lower-deductible plans.
Money accumulates in the savings accounts and can be withdrawn tax-free to pay for medical care. If not used, the money accumulates with tax-free interest until retirement.
"I saved $210 a month with this program over what I was paying," Bolig said. "My deductible was better with this program and I was able to contribute tax-free to this. It's just a great option."
For more information on this article, click on The Sun News
Health Care Tries Paying Doctors Based On Quality
Physicians and hospitals will likely soon be paid by insurers based on the quality of care they provide, rather than a flat negotiated fee.
Pay-for-performance programs that require doctors and hospitals to meet pre-determined quality levels for various procedures in order to get maximum payment are the new front in the battle to contain rising health care costs.
Health care providers are greeting the idea with tempered optimism as the idea is introduced in the Milwaukee market.
Dr. Jim Ketterhagen, president of the Medical Society of Milwaukee County, supports the concept of pay-for-performance, but questions how quality measures are set up and which standards are used.
Click on the The Business Journal of Milwaukee
for more information on this article.
Employers Seek Cuts To Offset Rise In Health Premiums
According to the Business Journal, health care cost increases are likely to average in the high single-figure or low-double digit percentages, lower than in previous years, but still steep compared with most other services businesses buy.
In response to the continued increase in health care costs, employers have turned to a variety of tactics, from changing plan designs to cutting benefits to simply shopping around for a better deal.
They're also trying to find ways to limit workers' health spending, in some cases even conducting audits to make sure, for example, that dependents employees claim really are dependents.
Frequently, employers will use multiple strategies in an effort to trim employee health expenses. For more information on what employers are doing to cut cost, click on Health Insurance
Teen Lifestyle: Help Your Student Athlete Find The Right Balance
Does your son or daughter participate in youth athletics?
About 30 million kids in the United States do. Teens play sports to have fun, learn new skills and spend time with their friends.
You'll need to help them get the right balance of academics, sports and rest, and teach them to make healthy choices.
Carbohydrates are the cornerstone of an athlete's diet. If your teen tells you about having trouble maintaining intensity during a workout or game, it may be because he or she ran out of the quick energy carbohydrates provide.
The exact energy needs of young athletes haven't been determined, but calorie needs can be much higher than usual depending on the type, intensity, frequency and duration of physical activity.
For more information on the estimated calorie needs of active teens, click on Mayo Clinic
Genes May Dictate How Exercise Benefits The Elderly
According to HealthDay News
, researchers have identified a genetic trait that may help to explain why some older people get fewer benefits from physical activity than others.
It's a variant form of the gene that controls a molecule called angiotensin-converting enzyme (ACE), which is involved in blood pressure regulation.
A British study had previously found that the variant gene affected the physical response of Army recruits who carried it, said Stephen B. Kritchevsky, professor of gerontology at Wake Forest University School of Medicine.
Those people, ages 70 to 79 when the study started in 1997, have made periodic reports of their physical activity -- not only exercise but also everyday activities such as walking and stair climbing. They also have reported any mobility problems they might have.
"One of our most important findings was that everybody did better with exercise," Kritchevsky said. "But people with this genotype did not get the best response."
Employers Weigh Costs, Benefits Of Traditional Vs. High-Deductible Health Plans
Traditionally, employers have striven to offer the richest possible health benefit plans, a trifecta of high coverage levels, low employee premiums and low out-of-pocket expenses.
After several years of double-digit premium increases, however, most employers have become accustomed to cost-shifting through incrementally higher employee premiums, deductibles and co-pays.
But in the past two years, high-deductible plans have burst onto the scene, giving employers the option of lowering monthly premiums by offering a high-deductible plan that requires employees to manage health care spending.
At the same time, the plans transfer a great deal of financial risk and responsibility to employees, an option that would have been unthinkable for most employees even a few years ago.
No longer unthinkable, consumer-directed plans are the hottest thing in health care. Since their introduction in 2002, high-deductible plans have penetrated the market at twice the rate of HMOs when they came on in the 1980s.
To read more on how to decide what is right for your company, click on Business Journal
Mail Order Drugs Could Save U.S. billions -- Study
Ordering prescription drugs by mail rather than at a store pharmacy could save the nation's insurance program for the elderly and disabled up to $86 billion over 10 years, a study released on Tuesday found.
The study, released by the Pharmaceutical Care Management Association (PCMA), also found drugs-by-mail are 10 percent cheaper than those bought at retail outlets.
Lower overheard costs, bulk purchasing and fewer dispensing errors help keep mail order prices lower, according to the study conducted by health care research firm The Lewin Group.
PCMA said the difference could help Medicare save money as it implements its controversial new prescription drug benefit for 2006.
Bush administration officials now estimate the benefit, required by law, will cost $724 billion by the year 2014. Earlier estimates said it would cost $400 billion over 10 years.
For more information on this article, click on Reuters
Some Employers Linking Employee Premiums To Health Screening Programs
As more employers require employees to take greater financial responsibility for their own health care as part of the consumerism movement, some employers are going even further, tying employees’ premium contributions to their participation in health risk appraisals and, in some cases, to improvements in health status.
"We baseline people, we give them education tools, help counsel them to improve their health, we establish accountability and the expectation is that their health score improved the next year. And their score is solely based on medically derived biomakers or metrics. It’s all in the blood," Hodgdon says.
To read more on this article, click on Work Force Management
IBM Employees Quit Smoking
According to an article in the San Francisco Business Times, IBM is putting its money where its employees' health is.
The computer giant spent $25 million last year, including about $1.3 million in the Bay Area, on "rebates" to employees who took tangible steps to pursue healthy lifestyle choices such as exercising regularly and not smoking.
It expects to expend similar sums this year, as part of a "long legacy" of being supportive of its employees, said Joyce Young, global director of "well-being services" and health benefits, based in IBM's Research Triangle Park, N.C., offices.
Workers who don't smoke get a $150 a year bonus, as do those who sign up and meet the commitments for a physical activity program that requires a weekly minimum of three exercise sessions lasting at least 20 minutes each.
IBM believes the programs will help it lower overall health-care costs, reduce absenteeism, enhance productivity, cut workers' compensation and disability costs, boost morale and improve employee recruitment and retention efforts.
"Preliminary data shows that (health-care) claims costs for people who exercise (in the IBM programs) are about $350 less annually than for those who don't," Young said. And other benefits-related costs are also expected to drop.
Exercising With Arthritis: Improve Your Joint Pain And Stiffness
Exercise is critical for people with arthritis.
It increases strength and flexibility, reduces joint pain and helps combat fatigue.
Of course, when stiff and painful joints are already bogging you down, the thought of walking around the block or swimming a few laps might make you cringe.
You don't need to run a marathon or swim the pace of an Olympic competitor to help reduce the symptoms of your arthritis. Even moderate exercise can improve your pain and help you maintain a healthy weight.
For more information on this article, click on Mayo Clinic