A prevention-focused accountable health plan

By Stuart M. Sutley, Founder and Managing Director of IWS, LLC

Frustrated by not finding a solution to rising health care costs? Frustrated by not having data at your fingertips to manage your health benefits? Frustrated by not being serviced with a strategy and vision that integrates your health plan under one umbrella? A Population Risk Management™ (PRM) strategy offered by industry leader Innovative Wellness Solutions (IWS), LLC is the solution.

What makes IWS unique? We have integrated a full-service, comprehensive wellness company with the ability to manage and even pay claims to produce quantifiable, accountable results. The principals of IWS have backgrounds in self-funding, plan management, benefits administration, TPA management, Disease Management and Comprehensive Wellness program implementation. This experience allows us to share an unparalleled knowledge in service and cost containment regarding health care delivery. We know the potential pitfalls and problems associated with choosing, implementing, and administering an integrated benefit plan.  We also know how to drive participation and garner exceptional results in health promotion programs. We work with you on plan design, cost reduction, changes in the marketplace, key regulatory issues, and alternative funding options while creating a healthier and more productive workforce through prevention and compliance. As one of only fifteen URAC accredited Comprehensive Wellness organizations in the US, our commitment to quality, confidentiality and consistency of results make us a leader in the marketplace.

Information sources such as claims and pharmacy data can provide important, complementary insight on where the trends are putting a benefits-eligible population at-risk. This data, combined with a Health Risk Assessment and Biometric screenings will provide a comprehensive view of the population for proper stratification purposes. Data collection and analysis are critical because they provide a way to measure progress and they provide metrics for managing and communicating information that will drive the necessary behavior changes in employees and dependents. At IWS, our goal is to identify all the gaps in care of a benefits-covered population and get these gaps eliminated through use of a Primary Care Physician (PCP) or other health care provider.

Worksite wellness programs have been in existence for more than 25 years. Driven by organizations that wanted to provide a better workplace for employees, these programs were viewed as a perk more than a business strategy. However, within the last five years, there has been substantive recognition that wellness programs are one of the last options to take cost out of the Health Care system.

The only remaining variable of consequence to control the costs for employer-provided health benefits is the proper utilization of an organization's health plan. Plan costs continue to go up and the fees to administer those plans are rising. Lack of understanding by employees and their dependents on what benefits they have and how to use these benefits continually increases costs. Take the example of the employee who does not have a Primary Care Physician and uses the Emergency Room as a doctor's office. Or the employee, or the spouse of the employee, who does not realize that the health plan covers pre-natal care? In both of these cases, lack of understanding and improper use of available benefits are key drivers to our nation's runaway health costs. We need to stop unnecessary consumption.

And what about the simple step of preventative care? This is wellness at its most basic form. Proactive health care will decrease unwanted plan utilization by advocating and encouraging plan participants to engage in positive lifestyle choices to find their own best health. In addition to lifestyle choices, preventative "wellness" care must include health compliance matters; are eligible employees and dependents getting their mammograms, PSA tests, colonoscopies, etc. on an age and gender prescribed basis? Do employees and dependents have Primary Care Physicians and are they having annual exams? Do they know what tests to ask their PCP to perform and do they know what the results of those tests mean? All of this care is dependent upon health education and benefits coverage, which most people say exists outside the scope of wellness programming. Or does it?

A good benefits plan is a critical part of attracting and retaining the highest quality employees. Navigating the different options and finding a plan that stays within your healthcare budget and offers the best care options for your employees is challenging. The amount of data available to companies regarding their health plans and specific employee populations is astounding and is critical to your future strategy.  Analyzing and auditing medical, pharmacy, eligibility, case and disease management information can dramatically impact health care costs. In the past, employers have tried to combat rising health care costs by changing the quality of benefits offered or shifting the added cost to the employees. Understanding the data behind a plan and auditing the carriers plan to ensure accuracy and efficacy are two important ways to reduce healthcare costs. At IWS, we help employers by leveraging the data that is already available to them.

It is recommended to tie initial engagement into premium reductions or increases. For the first 1-2 years, not all covered lives will participate. Take the excess contributed by those not participating and use for paying for much of the program costs and/or additional incentives for on-going engagement. As employers get increasingly serious about driving better health, strategic implementation of aggressive incentives that ultimately penalize non-participants are becoming the norm. As an example, non-compliance with a prescribed care regimen could result in a reduction in benefits. Changing the culture to accept individual responsibility will happen over time with the right communication strategy. Participation rates of 80+ percent are achievable, which is necessary to drive a return on investment.

Keep your benefits plan competitive by working towards zero trend. It's good for your employees, their dependents and the bottom line of your organization.