Engaging membership

Lisa Kime explains how a value-based program helped Greenheck Fan increase disease management participation and lower overall trend.

Greenheck Fan Corp. is a leading manufacturer of air movement and control equipment. Its flagship ventilation products are typically found behind walls, in ductwork, or on the roofs of hospitals, office buildings, hotels, shopping malls, restaurants, schools, industrial plants and other commercial buildings.

The company prides itself on innovation - not just in the products and solutions it offers customers - but also in the design of the health benefits plan it offers employees and their families. 

Like many employers, Greenheck offered a disease management program in order to help high-risk plan members more effectively manage their chronic condition(s). Disease management programs are designed to save both employers and members the cost of major medical expenses down the road.

The challenge Greenheck and others have found, however, is in trying to persuade members with chronic conditions to participate in disease management programs. For many members, managing a chronic condition can cause financial hardships. In fact, employees receiving care recommendations from their disease management coach may sometimes avoid seeking timely treatment because of the out-of-pocket costs.

Working with UMR, Greenheck Fan Corp.'s Jay Zastrow, compensation benefits supervisor, and Debbie Kasten, benefits coordinator, thoughtfully launched a progressive value-based program to help their plan members create a connection between their health and wealth while managing a chronic condition.

Recognizing the need to drive consumerism, Greenheck implemented a full-replacement health reimbursement account (HRA) benefit strategy, giving members a shared financial responsibility to manage their health care spending. In addition, Greenheck introduced care-targeted benefits (CTB) to pair with its existing disease management programs.

The CTB program allows team members diagnosed with one or more of five common chronic conditions to access an additional pool of benefit dollars in return for participation in one-on-one coaching and disease management programs. Together, the HRA and CTB benefit strategies give members incentives to better manage their health with tangible financial rewards.

"Greenheck chose to implement the CTB program to reward those participating in disease management by providing additional HRA dollars to help with the medical expenses for the chronic condition they are working to keep under control," Kasten said. "When the illness is kept under control, the cost to the member and to the medical plan is reduced; the member becomes involved with his or her health care, making better use of the health care dollar. Everyone wins."

Participants can use earned CTB dollars to offset out-of-pocket and member responsibility expenses incurred through treatment of their conditions as well as for hypertension and depression (two co-morbidities that often accompany chronic conditions).

CTB helps motivate employees with chronic conditions to take control of their health and reach out for help from knowledgeable coaches. Together, the coach and employee can set a specific, measurable plan for managing health issues.

Members can track their CTB dollars online. Earned dollars are automatically applied to out-of-pocket/member responsibility amounts through integrated rollover processing on eligible claims (with specific diagnosis codes). With this proactive and innovative program, Greenheck has been able to help employees understand the tangible value of pursuing better health as well as the welcome side effect of enhanced financial savings.

The results have been impressive with disease management participation surging from 21 percent in 2008 to 64 percent in 2010. Per member per month expenditures also dropped by 42 percent among CTB participants and overall trend for all members is almost 30 percent lower.

"This is a confidential program, but of the members that have contacted me with questions, they are appreciative of both the disease management program and the additional HRA dollars targeted to the condition they are working to manage," Kasten said. "They are pleased to be able to have a positive impact on their health and in controlling the medical plan expense to the company and their own bottom line." 

Customer: Greenheck Fan Corp.

Industry: Air movement and control equipment manufacturer

Challenge: Persuade members with chronic conditions to participate in disease management programs.

Solution: A progressive value-based program, including a care-targeted benefits (CTB) component, to help plan members create a connection between their health and wealth while managing a chronic condition.

Benefits: Substantial increases in disease management participation and significantly lower per member per month expenditures and overall trend.

About

Lisa Kime is Vice President of Account Management for UMR, the third-party administrator (TPA) unit of UnitedHealthcare. Kime has over 20 years of health care industry experience, including the last 15 with UMR. Prior to joining UMR, she held positions at Kaiser Permanente, including patient advocate and account executive.