Mock Surgery day

The 19^TH Annual Mock Surgery day at Brackenridge Hospital was a huge success. Approximately 1500 people attended the event. A wide variety of groups and organizations were represented as they shared information on various topics pertaining to good health and general safety. Those who attended learned about subjects like; kidney disease, diabetes, cancer, fire safety and more. The hospital also had staff on hand to show people how to bandage wounds and even the trauma department was represented.

Vantage Outsourcing was invited to participate in the event and for the first time ever cataracts were covered. Information was shared, which answered a variety of questions, such as:

• What is a cataract?
• How does it form?
• Who can get cataracts?
• How long does the procedure take?

Along with this information, the cataract surgery was described, the surgical instruments were on hand for viewing and some of the different types of lens implants were discussed. Overall, a lot of information was provided.

Vantage Outsourcing had a great time at this public event and is looking forward to further the publics knowledge when it comes to Cataract Procedures.

Mock Surgery Day

Brackenridge Hospital in Austin, Texas is having a “Mock Surgery Day” on 2/6/10 from 8:00am-3:00pm. In the Clinical Education Center, of the hospital, there will be designated areas set up as operating rooms. Each area will reflect different surgical procedures performed at the hospital. Medical staff will be on hand to talk about what happens during surgery.

The program is designed for kids and adults alike. Scrub attire and surgical masks will be provided for visitors so they can really “get a feel” of an OR environment. The event takes approximately 2 hours to go through.

For more information please contact: Elois Currivan or see their website at (http://www.seton.net/clinical_education_classes_and_events/classes/mock_surgery)

Supporters of the project included Vantage Outsourcing whom’s Cataract Division will be assisting the hospital in demonstrating the various aspects of Cataract Surgery.

#1 Priority for Your Front Office Team

A surgeon can be the best surgeon in the area or the world, for that matter. But, if his/her front office isn’t doing its job right, this expertise means nothing. It’s the equivalent of having the best quarterback on the field, but the front line can’t block, the running back can’t run and the receivers can’t catch. A team simply can’t win, with only one effective player. So how effective is your team?

As in football, a front office must know the drills and apply them daily. First, they need good people skills. It’s a MUST that they always put the patient first. As the saying goes, “if Mama ain’t happy, ain’t nobody happy!” How does this apply to your patients? Think about it, if your staff mishandles an issue in the front office, they’ve not only upset the patient, but the patient’s family/friends and everyone sitting in your front office, i.e. other patients and potential customers. If you can do one thing for your staff, teach them how to handle difficult situations. First, train them to live and breathe the two rule standard as an initial reaction to a disgruntled patient: “Rule #1 – The patient is always right, Rule #2 – If the patient is wrong, refer to Rule #1.” By making the patient feel that they are right, the anger and emotions surrounding the situation are diffused immediately. Second, in resolving a patient issue, take them to a private area and work through the patient’s issue in a positive manner. If a staff member has done something wrong, require that the staff resolving this issue with the patient do 4 things: (1) admit wrong doing, (2) openly acknowledge what was done incorrectly, (3) apologize for the mistake, and (4) come up with an action plan that you will implement immediately to ensure this doesn’t happen again. If your staff does this, it’s a guarantee that your patients will come back, as well as become life-long customers and most importantly, tell their family and friends of the great experience they had at your office and/or surgery center and what a top notch ophthalmologist you are.

The second most important duty of front office staff is how they treat each other. The Golden Rule is always a good place to start. This rule is “treat others, as you would like them to treat you.” If you instill this in each and every one of your people and let them know that you expect them to live this daily, your personnel issues will be minimal. In the last year, one of cataract outsourcing team members violate this rule. Rather than treat it as an isolated incident and address with only this particular staff, the supervisor gathered the entire group together the day after the episode and presented them with a one page statement. He read it out loud and had discussions with them what this meant on an individual level, as well as a team. He went over points about how our society, as a whole, has become less professional and respectful of each another. They discussed this and it was agreed that the team needs to work harder in making sure these types of behaviors/attitudes don’t permeated their work environment. They discussed how they could have handled the situation differently. In the end, the supervisor, along with each staff member, signed this document acknowledging their pledge to treat each other professionally and with the utmost respect, at all times.

Another aspect of front office service applies to your facility staff. If you haven’t already done so, you need to encourage, promote, and require your facility staff to treat your office staff with the upmost respect and view them as a key customer. In addition, they need to do the same for all surgeon users’ office staff. Your people must view these groups of people as key customers, i.e. same top notch customer service, as the staff gives the patients. Granted not all physician offices have the greatest customer service-oriented people working their front desks. But, encourage your staff to look beyond this and to keep reminding themselves that a surgeon’s staff is the gatekeeper of the facility’s patients. Again, if these key people are happy, I’ll guarantee you the facility case load will increase.

Finally, your staff needs to be dutiful in completing the tasks of scheduling, pre-certing, registering, preparing patient for surgical protocol and expectations, billing and collecting payments. However you might remind them that if poor customer service exists and/or prevails, there will be no need to pre-cert, register, etc…, as customers will be non-existent. Therefore, the #1 priority must always be customer service to both external and internal customers.

Red reflex test to all newborns recommended

Physicians at The Vision Center of Children’s Hospital, Los Angeles, are strongly advocating a basic eye exam, including a red reflex test, be given to all children shortly after birth, the center said. Angela Buffenn, M.D., M.P.H., Director of the Orbit and Eye Movement Institute and Diana Dennis, M.A. of the Therapeutic Living Center for the Blind, reported on the problem of inadequate childhood vision screenings in Pediatric News. The red reflex test involves looking at the infant\’s eyes through an ophthalmoscope in a dimly lit room to see if there are any abnormalities in the back of the eye or white spots in the eyeball. The test is used to screen for abnormalities in the eye itself as well as ocular misalignment. If the red reflex is found to be abnormal, the child should be examined by a pediatric ophthalmologist in order to test for strabismus (crossed eyes), cataracts, glaucoma, retinoblastoma, retinal abnormalities, and high refractive errors. Oftentimes, the test is first administered by a pediatrician or family physician. The red reflex test has been endorsed as an important part of a well child visit by the American Academy of Pediatrics and the American Academy for Pediatric Ophthalmology and Strabismus.

“Too often we see children with developmental delay whose visual system has not been properly evaluated. Sometimes, parents also think that vision loss is less important than treating the seizure disorder or developmental disability, when the truth is we can address both at the same time,” said Dr. Buffenn.

Retina tops online health forum inquiries

According to an analysis of questions asked on MedHelp, the American Academy of Ophthalmology’s health information Web site, concerns related to the retina topped the list—almost 20% of the 4,485 questions posed over a 6-month period from Sept. 2008 through March 2009. According to John C. Hagan, M.D., and colleagues, many people asked about or retinal detachment. About 19% of questions were related to the cornea. Cataract and implanted lens questions were next in prevalence, followed by brain-eye problems (neuro-ophthalmology), children’s eye alignment (), eye cancers, and general discomfort or blurry vision.

Two-to-three percent of questions related to each of three vision correction topics: refractive surgery . A smaller number were related to eye care products or medical insurance. The analysis also found many people submit postings to express their gratitude for the medical advice provided.

Cataract does not affect AMD progression

Age-related macular degeneration (AMD) does not appear to progress at a higher rate among individuals who have had surgery to treat cataract, contrary to previous reports that treating one cause of vision loss worsens the other, according to a study in Archives of Ophthalmology. Because both conditions are strongly age-related, many individuals with cataract also have AMD, the journal said in a news item. There has been a long-standing controversy among clinicians as to whether cataract surgery is contraindicated in eyes with non-neovascular AMD. A major concern has been whether cataract surgery increases the risk of progression to neovascular AMD in eyes at risk of progression such as those with intermediate AMD.
Li Ming Dong, Ph.D., of Stony Brook University School of Medicine, N.Y., and colleagues studied eyes of 108 individuals with non-neovascular AMD who underwent preoperative assessments for cataract surgery between 2000 and 2002. Photographs of the retina were taken and fluorescein angiography, which uses a special dye to investigate blood vessels in the eye, was performed. A total of 86 evaluated eyes had non-neovascular AMD before surgery, and 71 had follow-up assessments between one week and one year after surgery.
Neovascular AMD was observed in nine (12.7%) of these 71 eyes at one or more follow-up assessments. Five eyes displayed signs of neovascular AMD at the 1-week follow-up point; the size and location of the lesions identified indicated that they may have been present before surgery but not visible due to the opaque lens caused by cataract. When these eyes and one eye that did not have 1-week follow-up photographs available were excluded, the progression rate between 1 week and 1 year decreased to three of 65 eyes (4.6%). The rate of progression to neovascular AMD was similar among participants other, cataract-free eyes over the same time period (3%).
The authors do note earlier reports may be biased with the absence of immediate postop fluorescein angiography. An accompanying editorial notes the diversity in study findings may be due to study design and that much work is still needed before steadfast conclusions may be made.

Additional drug benefit possible

Though a two-tier formulary for generics and brand-name drugs was cutting edge 20 years ago, this decade has given rise to the three-tier formulary, according to Perry Cohen, president of The Pharmacy Group. He predicts the third tier will likely expand within the next 20 years.

Respondents to MANAGED HEALTHCARE EXECUTIVE’S annual survey largely indicated (39.9%) that they have a three-tier formulary plan in place. Cohen says the third tier is going to change to include specialty health benefits on top of the existing medical and pharmacy benefits.

“Specialty health benefits will deal mostly with drugs that are currently in tier four and five, because they are specialty drugs that cost perhaps $10,000 a year,” says Cohen. “So, over the next 20 years you’re going to see traditional drugs covered under a three-tier copay system, but that third tier is going to get more funky.”

A separate benefit will have to be broken off, not because of cost, but because the patients on those drugs need a lot of case management and the population numbers are small, Cohen says.

“So the incidence is really small, the drugs are expensive, and they need a lot of case management to go with it, such as tracking, use, genetic testing—and all those things are going to lead to a third category of health benefits, called specialty health benefits.”

In addition, Cohen says the market is moving from drug formulary management toward drug utilization management.

Quality Models

Five years ago, Aetna and several large employers confronted Virginia Mason Medical Center in Seattle over how much it was charging for treatment of migraine, severe acid reflux and narrowed aortic valves, and other conditions. Virginia Mason, a not-for-profit hospital system that employs about 400 salaried physicians, took the message to heart.

Working with the employers and Aetna, doctors and staff began to re-engineer care protocols. For example, the system ensured back pain patients same-day access to a physical therapist and physical medicine physician and sharply reduced medically unnecessary MRI tests and physical therapy visits. From 2004 to 2007, the changes yielded a 50% reduction in lost employee work days due to back pain, almost $2 million in cost savings and high patient satisfaction scores.

Following the overhaul, however, Virginia Mason’s spine clinic was losing revenue because of fewer billed tests and services. To offset the loss, Aetna boosted reimbursement for appropriate physical therapy sessions. With the higher payments and the greater volume of patients it could handle under the more efficient system, Virginia Mason covered its costs—while payers achieved a significant net savings.

President Obama and health policy experts have specifically touted integrated delivery systems, such as Virginia Mason, Geisinger Health System, the Mayo Clinic and others, as national models for innovation. Dartmouth University researchers have found, for instance, that Mayo spends one-third to one-half less than other top hospitals to care for similar patients with equal or better results.

Geisinger has gotten so much attention from politicians that it reportedly hosted tours for more than 70 visiting payers and providers last month.

Leaders of integrated delivery systems say the model won’t work just anywhere. It’s challenging to build a culture of high quality and low costs through contractual relationships. Independent delivery markets don’t have the dynamic of salaried doctors and instead must manage the powerful fee-for-service forces.

Robert S. Mecklenburg, MD, medical director of the Center for Health Care Solutions at Virginia Mason, says his system’s experience shows how health plans and employers can benefit from collaborating with an integrated hospital-physician group. But, he adds, moving away from fee-for-service to payment models that reward better patient outcomes, higher patient satisfaction and lower costs is key.

“[Innovative providers] want to be paid for value,” he says. “That’s very important in straightening out U.S. healthcare.”

Mayo Clinic CEO Dr. Denis Cortese describes integrated systems as having high levels of physician engagement, teamwork, connectivity and greater use of industrial efficiency and quality controls. All this is hard to achieve in contracted networks.

At the same time, experts say, non-integrated systems haven’t felt the pressure—or been given the financial incentive—to change because payers have been slow to revamp payment methods to encourage coordinated delivery. The current fee-for-service model simply rewards greater volume of services.

So far, Dr. Mecklenburg says, no health plans have agreed to pay Virginia Mason based on actual patient outcomes, except on a temporary experimental basis. He believes the system should realize a positive margin when it meets its quality targets.

“You won’t get system reform without changing the reimbursement dynamics,” says Andrew Webber, president of the National Business Coalition on Health in Washington, D.C. “I’m sure the leaders of integrated delivery systems are frustrated with the current payment system.”

ALIGNMENT OF INCENTIVES

At the state level, Massachusetts, with its individual mandate, now is eyeing a shift from fee for service to bundled payments to control spiraling costs.

In line with that, Blue Cross & Blue Shield of Massachusetts continues to leverage its Alternative Quality Contract with episode-based global payments, which pushes providers to work together on improving patient outcomes and cost-effectiveness, according to Jim Conway, senior vice president of the Institute for Healthcare Improvement in Cambridge.

The alternate contract sets specific outcome measures provider groups must achieve in managing patients with chronic conditions. For the first few years, provider groups won’t face financial penalties as long as they meet the process standards, but down the line, they’ll take a financial hit if they don’t meet the outcome targets.

“It took a while for the first hospital and physician group to sign up,” Conway says. “But now a lot of people are signing up because they see this as the direction the industry is going—away from fee for service to a system that takes care of overall global health.”

In other parts of the country, Blue Cross & Blue Shield of Minnesota also has started paying providers for care of the whole patient rather than for specific services, Conway says.

Self-insured employers are testing new reimbursement approaches as well.

Members of the Colorado Business Group on Health are paying providers additional reimbursement on top of fee-for-service payment to manage the care of diabetics and other patients with chronic conditions, according to Webber. They’re using a program developed by the Bridges to Excellence industry partnership. Similarly, the Employers Coalition on Health in Rockford, Ill., is experimenting with paying providers a bundled case rate for patients with chronic conditions, using the PROMETHEUS Payment System, of which Bridges to Excellence is the operational partner.

Webber says health plans and employers should offer financial incentives to patients to get their care from integrated systems, taking advantage of emerging value-based benefit designs.

“There will be opportunities to say to patients, ‘We’re willing to reduce your premium share if you’re willing to participate in more integrated, high-performance delivery systems,’” he says. “I think more and more consumers would be willing to join more closed-panel systems if they could reduce their premium share. Then we can reward high-performance providers in two ways: with payment differentials and with more patients.”

HOME TEAMS

Some health plans and employers around the country are working with provider organizations—and even small physician practices—to support the emerging patient-centered medical home model.

In the model, a primary care physician leads a team of allied health professionals to provide or facilitate each patient’s care needs, including self-care and prevention. The team uses data to proactively manage care for its entire patient population as well.

The Geisinger Health System in Pennsylvania and Group Health Cooperative, a Seattle nonprofit health plan that employs salaried doctors, have reported that their medical home pilots have reduced emergency room use and preventable hospital admissions, improved outcomes for chronic care patients and boosted patient satisfaction. They’re expanding the model to all primary care sites, but it’s costly to properly staff, train and equip practices to become effective medical homes. The practices must be adequately reimbursed to cover the extra patient management services and the forgone fees for service.

Health plans and Medicare have moved slowly on implementing the model, waiting to see evidence of cost savings and quality improvement.

“The medical home is a very important element, and we need to reward primary care doctors, because this can move us toward more integration of care,” Webber says.

Beyond the medical home initiative, Geisinger Health System has taken another step in aligning payment. The not-for-profit system, which includes three hospitals, a multispecialty group practice with 700 doctors and a health plan, is beginning to re-engineer care protocols, starting with coronary artery bypass surgery. Its payment methodology for the re-engineered services, called ProvenCare, bundles comprehensive care for the procedure at a fixed price, instead of piecemeal services and costs. Essentially, by bundling services and paying a flat rate, some risk is shifted to the provider, so it’s in the provider’s interest to deliver the best care, not more care.

Geisinger and its doctors identified 40 factors that produce the best outcomes for bypass operations and built a checklist that ensures those best practices are performed every time. Since its redesign went live early in 2006, Geisinger reports markedly improved patient outcomes for bypass surgery, including a 44% reduction in the 30-day readmission rate, a 21% reduction in patients with any complications, and a 55% reduction in re-operations for bleeding.

Geisinger similarly has redesigned care for hip replacement, interventional cardiology procedures, cataract surgery, obesity surgery and perinatal care.

Duane Davis, MD, chief medical officer of Geisinger Health Plan says Geisinger has gotten a “marketing buzz” out of ProvenCare. Employers like the fact they pay once for the product, just like for other goods and services. But surprisingly, no other health plans have taken Geisinger up on its ProvenCare guarantee deal, except for Geisinger’s own plan. Dr. Davis says he isn’t sure why that’s the case.

“That’s stupid,” says Jeff Goldsmith, a veteran industry forecaster based in Charlottesville, Va. “If a provider group is organized well enough to give you a guarantee they won’t have to readmit, I would rush to sign a contract like that. Maybe some attitudes need to change.”

Goldsmith says that health plans and provider organizations are leery about working together on global payment contracts because of the disastrous experiences with capitated contracts back in the 1990s. Many physician groups and hospitals formed joint ventures to accept these fixed-fee deals and suffered big losses. New structures aim to even out the economics with gainsharing.

WATER UNDER THE BRIDGE

However unfortunate, private practice is collapsing, and more hospitals are employing doctors and creating their own multispecialty, integrated delivery systems. That, Goldsmith says, will allow hospital systems to manage care with their employed doctors. Likewise, health plans may be ready to return to working with provider groups to manage their patient populations because current cost-control methods, such as external utilization review and patient cost-sharing, aren’t sufficient.

“I can’t tell you whether that mindset has changed and whether plans have decided they’ve run out of tricks and are ready to return to working with providers in a constructive way,” Goldsmith says.

Scott Armstrong, president of Group Health Cooperative, says, “our whole industry is in the process of trying to come up with an answer to how health plans can work with providers. How can [global payment] create alignment around common goals? We have to overwhelm the skepticism based on bad experiences in the past.”

Even beyond that, however, Geisinger’s Dr. Davis says it’s going to take time to make healthcare better and cheaper. While integrated systems like his offer important lessons, there are no “big bang” solutions. The primary care medical home is a good place for health plans to start aligning payment incentives for improved care.

“There’s a huge opportunity for the insurance industry to use its skill sets and work in partnership with the clinical side to coordinate very fragmented care,” he says. “If we don’t figure out how to do primary care and coordination better, in the long run, payers will lose anyway.”

While private-industry payers can work on reducing fragmentation, government-supported coverage continues to face budget challenges. As a result, even the highest quality, most efficient providers stand to lose further reimbursement as rates decline.

The Mayo Clinic announced early last month that its Rochester, Minn., clinic, which has treated patients from the Midwest and West, will only accept Medicaid beneficiaries from Minnesota and the four states that border it. Meanwhile, its Arizona location no longer accepts Medicare for patients seeking primary care at its Glendale facility after reviewing results from a two-year pilot project. Mayo leaders made the decisions to limit service based on the low payment rates in Medicare and Medicaid.

NCQA tracks plateau in quality yet increased reporting of measures

As if it weren’t bad enough news that healthcare costs continue to spiral upward, the benchmark quality report for 2009 from the National Committee for Quality Assurance (NCQA) reveals that quality has stalled somewhat. In fact, the report examined the link between the cost and quality of care and found little or no connection between the two.

“The State of Health Care Quality: 2009″ report examined quality data submitted by 979 health plans across the country that collectively cover 116 million Americans, a 9% increase over 2008’s sample.

“Hundreds of health plans have made the commitment to measure and report on the quality of care provided to their members. Those plans have made remarkable progress in improving care,” said Margaret E. O’Kane, president of NCQA. “But they can’t do this alone. It’s time for all plans and providers to step up to the plate and do the right thing for their members.”

The stagnation of quality came as a disappointing surprise after a decade of improvements and was seen in all areas of healthcare—private coverage, Medicaid and Medicare.

“The status quo is unacceptable,” O’Kane said during a press conference last month. “Overall, the [quality] gains are pretty small, particularly among the most vulnerable populations,” as plans serving Medicare and Medicaid patients failed to show noticeable improvement in many key quality measures for the third consecutive year.

Among the notable areas in which quality has stalled:

Only 46.4% of people taking anti-depressant drugs are monitored by their physicians;

34.1% of children prescribed medications for attention deficit hyperactivity disorder are seeing a doctor for follow-up care;

Half of patients previously hospitalized for mental illness see a physician for a follow-up visit;

45.3% of people are receiving colon cancer screening at the appropriate age; and

Only 42.6% of patients with alcohol or drug dependency are get treatment for the condition.

Despite those disappointing results, there were several bright spots. Among them were a 12% increase in the provision of beta-blocker drugs to Medicare patients who had a heart attack within the previous six months; nearly across-the-board high-quality care for asthma patients; and substantial gains in smoking-cessation efforts in the Medicaid population.

“Sometimes, a plateau is just a place to get your bearings and figure out what your next strategy is going to be, and that’s the kind of plateau I think this is,” O’Kane says.

The need to get healthcare quality back on the path to improvement is dramatic, however. NCQA says that if all health plans were able to perform as well as the top 10% of plans did, the United States would realize fewer deaths and save at least $12 billion in medical costs and lost productivity every year. If every American were able to receive care that matched the quality of that provided by those plans in the top 10%, the number of lives saved would range between 165,000 and 272,000 annually.

Where those saved lives come from might depend on geography; the New England region had the highest-quality health plans, while the South Central region of the United States came in last.

“Every American deserves to have quality care, and a diabetic in Alabama shouldn’t get poorer care than a diabetic who lives in New Hampshire,” O’Kane says.

Deeper data points revealed in health risk assessments

The employee health risk assessment (HRA) remains a powerful tool for employers, but uncertainty over incentive guidelines and frustration over participation rates can stall even the most innovative programs. The goal of an HRA is two-fold.

HRAs provide employees with measures of their current health status and future health risks as well as actions they can take immediately to improve health. Additionally, employers can use the HRA information—aggregated and de-identified—to develop a wellness strategy.

“Most employers recognize that you can’t manage what you do not measure,” says Michael Taitel, vice president, Alere Center for Health Intelligence. “If you are trying to manage the health of your population, you can’t achieve that goal unless you have the data that shows the prevalence of health risks, chronic conditions, and absenteeism and presenteeism rates in your population.”

More data can be better when it comes to health measurement. Alere offers a Health and Productivity Assessment (HPA), which analyzes the effects of specific health problems on work performance and absence.

“For example, we ask them to indicate if they are missing work because of a health condition,” Taitel says. “In another series of questions, we ask them to rate and compare their performance to other employees. So simply looking at risks alone only gives part of the picture.”

For example, many HRAs assess the presence of depression.

“We understand that depression plays a key role in an employer’s productivity losses, as well as overall benefit costs, so we believe it is an important component to study,” Taitel says.

Another feature of an effective HRA includes a link into personal health support interventions so that employees may be steered into programs that can provide assistance. Employees who require assistance may also be identified for contact by a health coach or for participation in special wellness or prevention programs.

DRIVING PARTICIPATION IN HRAS

According to “Wellness Programs, Survey & Sample Series,” published in February 2009 by Brookfield, Wisc.-based International Foundation of Employee Benefit Plans, only about 14% of employers have indicated participation rates in HRAs above 75%, while 18% of employers indicated participation rates of 51% to 75%.

Bryce Williams, director of prevention and wellness at Blue Cross Blue Shield of Massachusetts (BCBSMA), believes that best-in-class participation begins at 80%.

“When [80%] of a population completes an HRA, the data becomes more meaningful and informative to future program strategy,” Williams says.

LURING EMPLOYEES WITH CASH

Incentives are the most popular tool to encourage participation, and there are a number of carrot-and-stick approaches, according to Carl R. Mowery, managing director of SMART Business Advisory and Consulting LLC, a business advisory services firm based in Devon, Pa.

“Some employers have even required employees, as a condition of participation in the healthcare program, to complete an annual health assessment,” Mowery says. “Others will give discounts on premiums for those who complete a health assessment, and others will provide cash or gift certificates to the employees.”

The Equal Employment Opportunity Commission (EEOC) issued an informal opinion letter stating that requiring employees to participate in an HRA may violate provisions of the Americans with Disabilities Act (ADA). However, HIPAA had earlier outlined a recommendation that noted the incentive can’t be greater than 20% of the cost of the health plan. Most employers are currently following the HIPAA guidelines.

Much discussion has taken place on how to apply incentives for completing HRAs. The company can opt to pay cash or the incentive may be tied to reduced health insurance premiums.

“The important thing to keep in mind is that incentives do not have to be costly,” says Taitel.

In CIGNA’s experience, its clients with the best overall HRA completion rates have offered a reduced premium or cash payment.

“Incentives play an instrumental role as a mechanism to engage individuals to participate in HRAs and in other programs designed to improve lifestyle behaviors,” says Emelia DeMusis, CIGNA product manager. “Levels of participation in HRAs have been found to vary significantly depending on the type of incentive that is used to motivate participation.”

While DeMusis says that optimal participation rate is obviously 100%, she believes that “even at levels below 100%, such as 20% to 40%, there can be medical savings.”

WALKING THE TALK

Participation is greater when it is supported by management and when it is linked to a more comprehensive intervention, specifically when it becomes an instrument used to help shape the corporate culture.

Incentives are a useful tool, but the best thing employers can do to encourage participation is ensure there is organizational commitment to the process, Alere’s Taitel says.

“Top leaders must become wellness champions,” he says.

In fact, in a peer-reviewed study Taitel led last year, researchers found that the strongest predictors of HRA completion are the monetary value of incentives and the employer’s level of communication and organizational commitment.

In the study, organizational commitment was a metric that included communications, the level of employee involvement through committees and internal champions, and visible executive management leadership support through advocacy, program participation and allocation of resources.

“Perhaps the most important finding was that the higher the organizational commitment, the lower the incentive cost needed to be,” Taitel says.

BSBSMA’s Williams agrees. Communicating with employees in advance of an HRA launch can ensure employees have a clear understanding of what data from their HRA will be shared with their health plan and their employer, he says.

CASE IN POINT

Visible senior management support, an engaging wellness platform and meaningful data have been demonstrated at SPS New England (SPS), a Salisbury, Mass.-based construction services company with 211 subscribers.

Under SPS’s wellness program, which is offered through BCBSMA, employees who elect to participate receive a higher contribution (up to 20%) from the company on their health insurance premiums depending on several wellness factors. SPS’s goal is 100% participation, says the company’s CEO and chairman, Wayne Capolupo.

Participation includes completing the BCBSMA online HRA, as well as being individually screened for tobacco use and three health metrics (BMI, blood pressure and cholesterol) and setting goals to maintain or improve those metrics over the coming year. BCBSMA wellness consultants work with SPS to run analytics on the HRA data and identify population health risks, which inform future interventions.

“SPS’s company contributions to health insurance premiums are based not only on employee participation but also on whether employees meet the health goals they set for themselves,” Capolupo says. “In the long run, it is our hope that by focusing employees on their own health issues and high-risk behaviors, and providing services to attenuate those risks, that employee wellness will improve and lost time and claims will be reduced. As a result, SPS’s health insurance premium will be reduced.”

DIG DEEPER

Historically, HRAs were mortality based and data didn’t go far. Today, data analytics get more mileage out of HRAs.

“Analysis of HRA data at the population level is used to support client decision making by analyzing how current health risks impact future health status, costs, productivity and disability, by identifying the most appropriate health strategies to support a population and by monitoring health status and health changes over time.” CIGNA’s DeMusis says.

By employing the University of Michigan HRA and Trend Management System, CIGNA is able to forecast costs and health status, use targeted improvement strategies and recommend the optimal outreach method to engage individuals, according to DeMusis.

But, in today’s economy, can employers afford to implement full-scale HRAs? Overwhelmingly, experts believe employers can’t afford not to implement an HRA as part of an overall wellness program.

“These programs can help employers reduce turnover, increase productivity, improve employee health and help potentially high-risk individuals from becoming future high-cost claimants,” says SMART Consulting’s Mowery.

HRAs typically cost just pennies per member per month. It’s a small investment with high potential for return.

However, there’s no real ROI for an HRA alone, according to Taitel, who asserts that the value of an HRA comes in measuring the changes in health risks over time. Large employers can link HRAs to claims data to see actual changes in costs.

However, the real key is link HRAs back to meaningful interventions. To secure true value, employers must take the information and use it to build tailored and useful health and wellness programs.

Tracey Walker is a senior editor with Advanstar Communications.

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