July 2011 Self Funding Magazine by Employer healthcare Congress

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TABLE OF CONTENTS

EDITORIAL Editor-in-Chief

Jonathan Edelheit

Assistant Editor Jenny Dodson

FEDS SET EXPLICIT GOAL TO ELIMINATE FEE FOR SERVICE IN SELF FUNDED PLANS by Stephen George

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PRODUCTION Graphic Designer

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TABLE OF CONTENTS

LETTER FROM THE EDITOR ROB A BANK FOR HEALTHCARE THE ONLY OPTION IN 2011?

by Jonathan Edelheit

‘PEOPLE STRATEGISTS’ REVEAL KEY CSUITE SECRETS TO BEND THE TREND by Les Meyer

REFORM AND THE CLASS ACT: 03 HEALTH THREAT OR OPPORTUNITY? by Todd Grove

THE ROLE OF THE PROFESSIONAL CASE MANAGER IN NEW MODELS OF CAREDELIVERY by Patrice Sminkey

15 WHY WEIGHT! WALK by Teresa Scott Carano

DISEASE PREVENTION THROUGH HEALTHY LIFESTYLE CHOICES ~FITNESS AND PROPER NUTRITION by Deborah MacArthur

DIABETES AND ITS EFFECT ON FUTURE EMPLOYER HEALTH COSTS - GUIDANCE FOR EMPLOYERS by Jonathan Spero

18 MARKET BASED PATIENT CARE by Ralph F. Weber

FOCUSING ON HEALTH, WELLNESS AND PREVENTION IN THE WORKPLACE by Lisa M. Scotton

Copyright © 2011 Self Funding Magazine. All rights reserved. Self Funding Magazine is published monthly by Global Health Insurance Publications. Material in this publication may not be reproduced in any way without express permission from Self Funding Magazine. Requests for permission may be directed to info@SelfFundingMagazine.com. Self Funding Magazine is in no way responsible for the content of our advertisers or authors.

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EDITOR’S LETTER

ROB A BANK FOR HEALTHCARE THE ONLY OPTION IN 2011?

his indeed did seem like the only option for Richard James Verone, a 59-year-old from North Carolina, who robbed a bank on June 9, 2011 claiming this was the only way for him to get coverage; because they have to provide healthcare in prison.

Verone handed a note to the teller claiming he had a gun, and demanded $1 US dollar. After she gave it to him, he sat in the bank’s lobby waiting for the police to arrest him. He asked only for one dollar so that it would be clear his motive was not to rob the bank, but get arrested for medical care. He has no job, two ruptured disks and a growth on his chest. He hoped he would be sent away to prison for three years and that would allow him time to get all the medical care he needed to be healed. Verone told reporters, “If it is called manipulation, then out of necessity because I need medical care, I guess I am manipulating the courts to get medical care.” Unfortunately for Richard, it is estimated he will only get sentenced to 12 months in prison, and may not get all the medical treatment he intended to. I think as individuals, many of us who are involved in the healthcare and health insurance industry forget about the people who don’t have or can’t afford health insurance. We forget to put ourselves in their shoes, to feel their fears, pain and desperation. We are removed by it all, because while it is an emotional topic, we have health coverage, we may not be happy with it, it may be expensive, but we have it. It’s not a healthcare crisis; it’s a healthcare disaster. It’s not getting better, it is only getting worse, and the passage of healthcare reform legislation will just continue to degrade it as costs are increasing. Is this what America has come to? People committing crimes so they can get free medical care from the state while in prison? There are more and more Americans like Richard who don’t have jobs, and in the future small employers may be forced to lay off more employees because of rising healthcare costs. Many small employers are getting renewals on their group health insurance as high as 40%. That’s crazy! What happened to the promises of lower costs under healthcare reform? People are starting to finally realize, that’s all it was, promises, and we need real healthcare reform and soon.

Jonathan Edelheit

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HEALTH REFORM AND THE CLASS ACT: THREAT OR OPPORTUNITY? by Todd Grove

arch 23 was the one year anniversary of President Obama signing into law the health care reform bill, which includes the Community Living Assistance Services and Supports (CLASS) provisions. Many of the details of the CLASS provisions are not yet defined and will be developed through regulation, but as with all other aspects of this industry altering legislation, nothing will ever be the same â&#x20AC;&#x201C; both for consumers of health care and the brokers who serve them.

most of the health care reform in its present form. Some of the major concerns I hear fall into the following buckets:

Most brokers I speak with are very concerned about

Value proposition could be diminished. As a

Reduction in income. Most health brokers believe that their income will be adversely affected. Client Relationships may be threatened. Loyalty is becoming a very rare trait amongst even our most well entrenched clients and that could be shaken even further by an upheaval in policy design/pricing.

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consolidation of plans occurs, understanding the In some parts of the country, it can cost over differences between one broker and another may $100,000 a year. If we assume that nursing home become more difficult. costs will continue to reflect recent trends, by the year 2021, the average rate will have risen to about All of these are the perceived threats of health care $480 a day, or $175,200 annually. reform which will roll out over the course of the next two years. As a result of these alarming statistics, Senator Ted Kennedy made it his mission to include some Another school of thought lies around the benefit – albeit small and controversial – in the final opportunities the reform act presents, and we will health reform legislation. focus here on the CLASS Act as a particularly effective way for health brokers to combat all three What are the details of the coverage that of the concerns mentioned above. would be provided?

First, a bit of background

Most of the terms of the new CLASS program that passed as part of the Patient Protection and Affordable Care Act will be developed by the Department of Health and Human Services over the next few years. Certain terms are set in statute, including the following:

Why does health care reform include any provisions for long-term care? After all, no major medical plan – not even Medicare – presently cover LTC costs at all. Let’s look at why long-term care cost are so alarming and need to be addressed now with all employers and their staff: Enrollees will:

Of every 100 people over 65 years of age, 43% will • pay a monthly premium, through payroll need long term care.. deduction, that has yet to be determined, but most -Technical Report 1-01, Scripps Gerontology Center, February 2001 recent estimates indicate that the average premium 40% of the people receiving long term care are will be $180-$240/month; that premium could be increased yearly to ensure that the CLASS fund is working adults between the ages of 18 and 64. actuarially sound. -(GAO/HEHS-95-109 long term Care Issues, p. 7). When you reach age 65, you have a 40% lifetime • be covered on a guaranteed-issue basis. chance of entering a nursing home, and a 10% risk that you will stay there at least five years • be eligible for benefits for their long-term care - (U.S. Department of Health and Human Services). needs after paying premiums for the first 60 months of coverage (i.e., a 5-year waiting period) and have “The average length of stay in a nursing home worked at least three of those five years. (current resident) is 892 days” (The National Nursing Home Survey).

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• receive a lifetime cash benefit after meeting benefit eligibility criteria, based on the degree of impairment, which is expected to average about $75/day or more than $27,000 per year and is payable as long as the claimant remains disabled. Enrollees will be offered coverage through their employers and will be automatically covered unless they opt out. They can opt back in at a later time. Self-employed people or those whose employers do not offer the benefit will also be able to join the CLASS program through a government payment mechanism.

Bad Math

so many unanswered questions. What are the premiums, how are they set and where do they go once collected are but a few of the more pressing queries. Douglas Holtz-Eakin, who was the director of the Congressional Budget Office from 2003 to 2005, wrote concerning this issue; “Consider, the fate of the $70 billion in premiums expected to be raised in the first 10 years for the legislation’s new long-term health care insurance program. This money is counted as deficit reduction, but the benefits it is intended to finance are assumed not to materialize in the first 10 years, so they appear nowhere in the cost of the legislation.”

“Removing the unrealistic annual Medicare savings This part of health care reform is one of the most ($463 billion) and the stolen annual revenues from controversial – in large part because it creates Social Security and long-term care insurance ($123

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billion), and adding in the annual spending that so far is not accounted for ($114 billion) quickly generates additional deficits of $562 billion in the first 10 years. And the nation would be on the hook for two more entitlement programs rapidly expanding as far as the eye can see.”

Why should Benefit Brokers Care? First off, because they have to now. CLASS is not “voluntary.” Every worker is involuntarily and automatically opted into the program. Each employee or self-employed person must willfully opt out to avoid the program’s large “premiums” that will otherwise accrue by default. Second, CLASS is not “insurance” by its true definition. Insurance is for healthy people who want to prepare responsibly for the relatively small possibility they may become disabled or chronically

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ill. CLASS is in essence a “pre-payment” of care subsidized by the insurable for the benefit of the uninsurable. As a result of all these problems and concerns, why would an employer offer CLASS when a voluntary offering of true long-term care insurance would make so much more sense for the vast majority of his/her employees? The answer: Not many. Unfortunately, most benefit brokers are woefully uneducated on both CLASS and the multi-life offerings in the market. Therefore, they will not be able to position private sector options well when the employers start calling. But, with education comes opportunity. Employers need guidance. Brokers need clients. LTC insurance specialists bridge the gap and can accomplish the goals each party has throughout this turbulent period.

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The Best Defense… The average broker in America today still sells— and will continue to sell—one or two LTCi policies a year. Why? Simply put, they do not see it as their role with employers. As a result, they will never focus on comprehensive long-term care planning. So, how can the important subject of long-term care planning be addressed professionally and ethically with the millions of at-risk, actively working baby boomers? The only sensible and effective approach is through strategic partnering. Most agents who have been successful at providing LTC insurance have focused solely on this complex product and the emotionally charged sales process that accompanies it. They are never a threat or a competitor to benefit brokers because LTCi is all they provide.

The How-to’s of Partnering with LTCi Specialists Broker partnering is a challenging process – much more art than science. It must start with the realization by the broker that they need to work collaboratively to support their clients in the brave new world of health care reform. Once that fact has been accepted, the first step is to locate a professional and ethical long-term care insurance specialist. The best method for finding a specialist to work with is obviously word of mouth/professional networking. However, locating them can also start with a Google search in your area. One organization that is national with trained worksite specialist is LTCFP. Another, ACSIA, can also be identified on the web.

The CLASS Act is exactly what has been needed to When searching, designations can be helpful as crystallize attention by employers, LTCi specialists well. The two most common are CLTC and LTCP. and benefit brokers on this voluntary benefit. Of the two, CLTC is commonly accepted as the industry standard. • LTC insurance specialists need access to boomers where they work. Attend NAIFA and NAHU meetings. Many of the • Advisors need to fulfill fiduciary responsibility leading LTC specialists are involved on a local level and inform their corporate clients of the severe in these organizations. limitations of CLASS.

Questions to Ask When Interviewing These two disciplines perfectly support one Specialists another. The key is bringing them together in a way that benefits all parties involved. The importance of LTC insurance will continue to grow, as will the options on how to design and underwrite coverage. Therefore, it is in the best interests of all parties— benefit brokers, LTC insurance specialists and their clients—to develop trusting and mutually beneficial partnerships. This model will in large part transform the marketing of LTC insurance throughout the years ahead.

How long have you been in the field? Look for at least 5 years. If they were previously affiliated with a captive or career shop, that is a benefit because they received significant training and support. What businesses/organizations have you worked with? Experience at the worksite using simplified underwriting and a 60 day enrollment period are important.

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What carriers do you work with? Pick an agent who has appointments with many large, reputable carriers like Prudential, Mutual of Omaha and Transamerica. Captive agents are not effective in the worksite since “one size does NOT fit all” in this marketplace. Ask if the specialist is compensated identically carrier to carrier. This obviously avoids conflict of interest. What other benefit brokers do you partner with? You might as well find out about what your competition is up to. Maximizing the Relationship: Keeping it Productive – and Profitable Here are a few tips to help set appropriate expectations and develop long-term, mutually

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beneficial relationships that proactively address the issue of LTC planning with your client base: 1. Commit to addressing LTC – with all clients. The most common reason why benefit broker/ LTC specialist partnerships fail is lack of focus. Both parties get excited and a few introductions are made, then things fade to black. This is avoided by creating a marketing plan that both the benefit broker and the specialist document and sign off on. The most important element is consistency. Speaking with clients every week about LTC and a voluntary offering or carve out is essential. This proactive approach repositions the broker in the mind of the employer and he/she is seen as a valuable resource on health care reform – and the welfare of the employees.

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2. Don’t get greedy. Any specialist worth his/her salt will provide all the following on each worksite enrollment: • Vet carriers • Develop proposals • Implementation calls with carrier • Worksite case preparation • Enroller management if necessary • Proposal development and presentation • Enrollment presentations – on location/webinars • one-on-one meetings with all interested employees • • • •

Application scrubbing/processing List bill preparation and reconciliation Policy delivery Ongoing customer service on active cases

3. Re-Brand your image in community. The brokers who truly leverage their relationship with LTCi specialists take a proactive approach to addressing this benefit – and the concerns most employees have surrounding it. That is completely different from the majority of benefit brokers and as a result, provides real opportunity to differentiate their services in a highly competitive market. Incorporate CLASS into many discussions, include some aspect of it in advertising/ marketing pieces. LTC Education at the worksite will cut stress, improve productivity – and solidify your relationship with clients who are confused about this issue.

CLASS Act forces an acceptance of long-term care planning. Those brokers who view this as an opportunity by partnering with LTCi specialists will As a result, the broker will earn a percentage of the “ride the wave” of government mandated health reform commission, but generate significantly more income and be viewed as a resource rather than a “bearer of off of LTCi than at any time in the past. The adage “A bad news”. small percentage of a lot beats 100% of nothing” truly applies in this scenario.

Bio

Todd Grove, LTCP, CLTC is a founding partner of LTC Financial Partners and has specialized in this field for 20 years. Some of the publications he has contributed to are the New York Times, Senior Market advisor, National Underwriter Magazine, and the Portland Press Herald. He is a member of the Estate Planning Council of Maine and Past President of the Maine Employee Benefits Council. He can be reached in Portland at 207-772-5793 or todd.grove@ltcfp.net

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THE ROLE OF THE PROFESSIONAL CASE MANAGER IN NEW MODELS OF CARE DELIVERY Self Funding Magazine

by Patrice Sminkey

or professional case managers, delivery of care is accomplished through a network of resources. Whether case managers work in a hospital or other acute-care setting, for an insurer or third-party provider or in another venue, identifying the appropriate resources is at the heart of advocacy for patients. Now, as new models of care delivery continue to emerge, the professional case manager-particularly one who is board-certified--will be at the heart of these networks to coordinate care, facilitate communication and employ evidencebased practice in pursuit of positive outcomes. 1

have emerged is the patient-centered medical home (PCMH), which is led by the primary care community. The PCMH is a model of care delivery that requires a primary care physician to achieve a critical balance of clinical and administrative resources, all while recognizing Medicare reimbursement policies that put greater emphasis on outcomes.

Amid these new complexities in care delivery, primary care physicians must either try to do everything themselves--which while effective, is not efficient--or they must hire case managers whose roles and responsibilities are integrated into In the era of healthcare reform, healthcare the PCMH. Therein lies the challenge for primary organizations, clinicians and practitioners are care physicians, who may not be familiar with the pursuing continuous improvements in quality, roles and functions of a case manager. Physicians efficacy and efficiency. Among the models that who have limited knowledge of case management

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Certification (CCMC), which has more than 30,000 board-certified case managers, defines case management as: “a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client’s health and human services needs.”2 The CCMC’s most recent case management role and function study, which involved scientifically conducted field research with nearly 7,000 participants, identified and evaluated essential activities of case management, including: case management process and services, resource utilization and management, psychosocial and economic support, rehabilitation, outcomes and ethical and legal practice. Knowledge domains identified from the study were case management concepts, healthcare management and delivery, principles of practice, psychosocial aspects, healthcare reimbursement and rehabilitation. As an analysis of the study concluded, “…the activities and required knowledge will put case managers in an excellent position to distinguish themselves through certification as competent professionals who are able to contribute to the health and well-being of clients/patients, and the overall efficiency and efficacy of the health care system.” 3 Given this thorough analysis of case management--what professional case managers do and the knowledge that is required of them--it is only logical that new models of care such as PCMH would utilize best-in-class case management in the pursuit of quality, efficiency, and efficacy goals. Through board-certification, such as achievement of the The roles and function of case management Certified Case Manager (CCM) credential, must be performed by a professional case professional case managers attest to their manager, preferably one who is board competence, professionalism, adherence to certified. The Commission for Case Manager could erroneously utilize non-clinical staff for case management duties. Although nonclinical staff can be used for duties such as paperwork processing, use of these individuals to address patient needs is inappropriate and could expose the physician to liability.

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ethical standards and commitment to pursue coordination including the PCMH, disease- and continuing education, which is required for care-management programs, patient education, certification renewal. and emergency room diversion to primary care physicians. 4 New models of care delivery such as PCMH play to the strengths of the professional case The link between care coordination and manager. “These new models of care, which improved outcomes calls for use of qualified, are fashioned around networks of providers board-certified professional case managers and resources, still need to be coordinated within models such as the PCMH. By utilizing around the patient’s needs,” commented Dr. the skills and expertise of such highly qualified Maureen Boshier, RN, LP.D, MSN, MBA, case managers, physicians are able to extend FACHE, who is an independent researcher and their reach across a larger population of writer on healthcare issues and an assistant patients, improve quality, pursue health status professor at Eastern Virginia Medical School. improvements in patients and elevate the “This requirement emphasizes the role of the purpose of the PCMH. These positive outcomes professional case manager.” are at the heart of the goals of healthcare reform. As primary care physicians, clinicians and The care coordination component within new providers join forces in pursuit of significant, models of delivery such as PCMH is critical. measurable improvements in the quality of Care coordination, which is a central role of the care delivery, they must examine the strengths professional case manager, provides access to of each link in the chain of the network being the right care and treatment resources at the right established. A board-certified, professional case time, avoiding duplication and unnecessary use manager is a strong contributor to network, with of resources. proven competencies to achieve the goals that are integral to PCMH success. According to a recent study published by Southeastern Consultants, uncoordinated care in the United States costs an average of $240 billion a year, with the average annual cost for Patrice Sminkey, RN, is an “extremely uncoordinated care patient” more the Chief Staff Executive of than five times higher than for other patients. the Commission for Case Among the recommendations for improvement, Manager Certification according to study author Mary Kay Owens, (www.CCMcertification. R.Ph., C.Ph., president of Southeastern org), which is the first and Consultants and a Clinical Associate Professor largest nationally accredited organization at the University of Florida College of that has board-certified more than 30,000 Pharmacy, were interventions to improve care professional case managers.

Bio

REFERENCES 1.Boshier, M., “CCMC News and Views: Understanding New Order for Care Delivery,” Professional Case Management, Vol. 16, No. 4, July/August 2010, pending 2.Commission for Case Manager Certification, “Definition of Case Management,” http://www.ccmcertification.org/secondary.php?section=Case_Management, Accessed March 9, 2011 3.Tahan, H. and Campagna, V., “Case Management Roles and Functions Across Various Settings and Professional Disciplines,” Professional Case Management, Vol. 15/No. 5, September/October 2010. 4.Owens, M.K., “Identifying and Quantifying the Cost of Uncoordinated Care: Opportunities for Savings and Improved Outcomes,” 2010, http://www.sec-rx.com/~fhsllc5/sec-rx.com/images/stories/documents/Summary_of_SEC_Analyses_on_Cost_of_Uncoordinated_Care_2010.pdf

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WHY WEIGHT! WALK by Teresa Scott Carano

hile biometric screenings and tailored disease management programs can identify with laser sharp precision opportunities to save employers money, a program that prevents future health care costs warrant careful consideration. In total any savings in self insured health costs means more dollars for bonuses, expansion, new hires, training â&#x20AC;&#x201C; all uses that keep your business and America humming.

American Academy of Podiatric Sports Medicine. A brisk walk can burn up to 100 calories per mile. Metabolically it not only helps control weight but can control blood sugar and cholesterol levels. Walking creates the opportunity for educating and supporting healthy food choices.

From a cardiovascular standpoint, if walking is done aerobically, it can reduce blood pressure and improve the resting heart rate. Most cardiovascular rehab So consider a program that the majority if not all of programs include walking because of the rich benefits workforce members can join. A program that offers associated with this simple form of exercise. both measurable and visible results feels empowering and because it is social will foster goal setting. Create In addition to the health benefits walking also a walking program for workforce members. encourages social participation that facilitates team work within an organization. It stimulates creative Here are some interesting facts according to the thought and refreshes the mind by producing

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endorphins. Plus it develops healthy habits that can extend beyond work hours.

How to begin? First itâ&#x20AC;&#x2122;s important to get the commitment of senior management to any program and to align corporate policies to encourage the activity during or around work hours. Then get employees involved in the planning stages. Some items to consider are to provide walking trails on site or a map of walking trails that support the program. Create flexible work hours and encourage walking breaks. Include ways to track progress thru walking journals and create incentives like time off or raffles for those reaching walking goals. Create healthy competition among teams, locations or departments. The National Institute of Health website offers a simple and excellent 12 week walking program on line. It is ideal for the individual that is just beginning a fitness program. It gradually extends the length of walk time over the 12 week period. This offers both a safe and effective approach. during walking allows the participant to gauge if they are working in their aerobic range. Being in In addition, the American Heart Association offers an aerobic range maximizes the cardio benefits a complete program on their website. It includes and working beyond for long periods of time a map of walking trails nationwide and an app to is detrimental. So another option for a serious download to a cell phone so even road warriors program is to incorporate heart rate monitors. can take the program with them. Simply visit http://www.startwalkingnow.org/home.jsp Inspire more participation and raise nutritional awareness by partnering with a local fitness center Consider providing everyone with a pedometer. or group of personal trainers to create some walk The models that run around $20 provide the walker and learn seminars followed by a healthy lunch with calculations for calories burned, total miles, once a month. As a fitness instructor I know many total steps total, clock and stopwatch. Research people have the desire to improve their health shows that 5,000 more steps a day can greatly and fitness level but are unsure how to begin or reduce the risks of chronic diseases. The ultimate are intimidated by a fitness facility or gym. Some disease management initiative. simply feel the goal of an improved fitness level is beyond their reach. Creating a healthy pathway Most people walk only 3,000 steps daily. People by facilitating walking at work can be the doorway who use pedometers find the time to walk more. that provides them the confidence to seek positive Combining a pedometer with a simple talk test lifestyle changes. (http://www.nhlbi.nih.gov/hbp/prevent/p_active/walk.htm)

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When evaluating walking programs, also consider Nordic Walking. Most of the US is still not aware of this program and its benefits. Nordic Walking is also referred to as Pole Walking and originated in Finland in the 1930’s. While the Finns found it useful for off season ski training it gained in popularity and became an official fitness program in Finland in 1997. Today over 800,000 Finns regularly participate in this sport and the trend has spread throughout Europe and is beginning to gain popularity in the US.

to baby boomers that prefer an active workout but no longer run or jog.

Engaging the workforce and leadership in creating an environment that supports health daily is going to deliver benefits. It offers an additional tool in the employers’ wellness strategy. Its simplicity while often overlooked creates a solid foundation for the incorporation of other educational and behavioral changes that are sought by the participants and can produce major benefits for employers of all shapes Here are some key benefits: the program assists in and sizes! supporting upright and proper body alignment and burns up to 46% more calories then regular walking. It’s walking and more!

Bio

Plus, it provides a fitness program for individuals that need to minimize any stress on shins, knees, hips and back. This program incorporates modified ski poles (adjusted for height) and terrain and special shoes. The poles support the walker and create proper alignment and engage the upper body. The shoes facilitate a full range of motion and decrease stress to joints. It delivers a powerful full body workout. This workout can be a simple walk or a competitive walk incorporating drills, “off terrain” work and static balance work. The program is especially attractive

Teresa Scott Carano is the owner of Vita Sana Ltd a consulting company the offers wellness programs and project based consulting for benefit administrators, carriers and their valued partners. Teresa is also a certified Life/ Leadership coach and an active certified fitness instructor as well as a Master Instructor for Nordic Walking. www.yoursolutionpartner.com 614 570 2553

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MARKET BASED PATIENT CARE by Ralph F. Weber

ealth plans are expensive, because medical care is expensive. Will shopping across state lines for insurance fix that? Itâ&#x20AC;&#x2122;s a nice sound bite and will allow the insured to drop some of their own state mandates, but the biggest input to the cost of a health plan is the underlying cost of the medical care financed by this plan. If you buy a plan in Shreveport and

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use it in San Francisco, it will trend up in costs. During the yearlong healthcare debate, I did not hear ONE person ask why medical care is so expensive. They barely even asked why health insurance was expensive, but if 85% of the premium for health insurance must be paid out in medical costs with the new medical loss requirement--and we have not addressed the

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cost of medical care--then insurance premiums will CONTINUE to rise at an unsustainable rate. Enacting health insurance reform without addressing the cost of medical care is like putting a new roof on a building which was in an earthquake.

Here’s how the Feds put the fix on health care pricing. It all starts with a Federal agency called the Center for Medicare Services (CMS). They set the reimbursement rates for some 14,193 medical procedures. How they come up with these figures is based on a “secret formula” calculated like most government methods of accounting. Then CMS pays the AMA (American Medical Association) to produce and manage “secret codes” called Current Procedural Terminology codes (CPT codes). The AMA then sells these codes to all doctors and hospitals, and insurance billing clerks. Altogether, they receive annual income reported to be $69.9 million, to manage these codes. Insurance companies then use the reimbursement rates as a starting point in determining how much should be covered as an insurable benefit under the term, which you no doubt recognize as “coinsurance”. In any business model where prices are fixed and paid by a third party, the patient (consumer) and doctor (provider) both have an incentive to consume more services than may be needed to gain maximum benefit. This is why these programs have become entitlements, rather than indemnity programs. If patients travel to Kansas for a bunionectomy, New Jersey for a knee replacement or Oklahoma for a Coronary Artery Bypass Graft--and you allow doctors and hospitals to compete across state lines with their

own rates, THEN you will achieve fair market rates and sustainable costs. Each doctor and hospital has different costs for different procedures, and each medical provider includes different services with any given procedure. When a third party arbitrarily decides to pay Dr. X in Los Angeles the same as they pay Dr. Y in Miami, some doctors will be overpaid for certain procedures and underpaid for others. Patients will receive “cost effective” procedures, which may not be what they really need. How many times have you turned on the television and heard a vendor offer, “If you have Medicare, we’ll get it paid for, or you get your scooter free.”? Would you get one if you had to pay $25,000 of your own money? Take your car to a body shop and get an estimate to fix a dent. Then say, “Oh, I forgot to mention, I have insurance”. The price will suddenly go up. This is because both the consumer and the provider are spending other people’s money. So how can we address the costs of medical care? By allowing doctors and hospitals to compete across state lines--not just insurance companies-and by having the patient see the true cost of the care and direct their own care--a key element completely missed in healthcare reform. In recent years, an industry known as “Medical Tourism” has emerged and is projected to grow at an estimated 35% per year. Medical tourism brokers send people overseas with “promised” savings which compare “billed rates” in the US to “paid rates” overseas. There often exists an added incentive for these brokers to send you overseas in the 20% to 80% or more that they get in kickbacks from the facility they send you to. These kinds of kickbacks are illegal in the US, so

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these brokers usually wonâ&#x20AC;&#x2122;t refer you to a US facility. Deloitte estimates that by the year 2017 as much as $599.5 billion per year of medical care revenues could be lost from the US in favor of overseas facilities. There is a very important place for overseas medical facilities in caring for US patients, but they are often not competitive on price. When US doctors and hospitals are permitted to set their own rates, they can usually compete very favorably with overseas facilities. A service such as MediBid.com allows patients to shop domestically as well as internationally and define their own criteria for medical care. The status quo, and the reformed healthcare model lack transparency, as well as financial incentives for both provider and consumer to reduce costs. To reduce costs while encouraging technological improvements, we need to introduce competition among doctors and hospitals.

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Bio Ralph F. Weber, President of MediBid, started an international health insurance brokerage in Canada, then moved to the U.S. and expanded his brokerage. Ralph has contributed healthcare reform policy to Rudy Giuliani and Mike Villines. Driven by a passion for greater access and transparency, Ralph and private investors started MediBid, a truly free-market solution to healthcare.

FOCUSING ON HEALTH, WELLNESS AND PREVENTION IN THE WORKPLACE Self Funding Magazine

by Lisa M. Scotton

hen it comes to employee health and productivity, the time for reactivity has passed. Today, employers are increasingly taking a proactive stance to improve employee health and wellness and to prevent injuries and illnesses that cause lost time, reduced productivity and higher medical and disability related claims costs. The shift is particularly significant among large employers who have the resources and a sizable employee population to warrant rolling out health and wellness interventions, which may range from education on health risks and screenings to onsite clinics and other facilities. Regardless of the specifics of the interventions, the important commonality is the emphasis on prevention rather than solely dealing

with illnesses and injuries after the fact. For employers, the benefits of taking a proactive approach are clear: reducing costs associated with health care and disability benefits and bolstering productivity as valued employees remain healthy on the job. For employees, participating in wellness and prevention programs not only supports their health but also helps to preserve their earnings power. Disability benefits typically pay a portion of the employeeâ&#x20AC;&#x2122;s regular salary or wages. This factor was particularly important during the recession when there was evidence that some employees with chronic and acute conditions were staying on the job, rather than going out on disability because of fears over job security and the need to protect wages. A far better approach to preserving earnings is by improving

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Varying Initiatives Initiatives vary from employer to employer. They may include onsite health screenings and educational programs to promote awareness and improve self-care or specific health offerings such as mobile mammograms and flu vaccinations. Employees with chronic illnesses or lifestyle risks may also receive “check-ins” from occupational health clinicians, case managers or health coaches who work for the health insurer. More extensive interventions bring resources to employees, such as onsite occupational and primary care health clinics and fitness facilities. For example, an employer in Massachusetts recently installed a gym on site that can be used by employees for recreational fitness and exercise as well as for medically prescribed physical therapy. Onsite facilities can help increase participation in health, wellness and prevention initiatives and improve adherence to physicians’ orders regarding diet and exercise, while reducing employees’ time away from work to receive therapy services. wellness and prevention and decreasing absences To maximize cost-effectiveness and efficacy, due to health issues. employers are increasing integration among programs, which raises awareness and facilitates In a position statement, the American Association of referrals. For example, an employee who is off Occupational Health Nurses (AAOHN) championed work due to an occupational injury that is covered the use of health promotion in the workplace as part by workers’ compensation may be referred to health of an overall strategy to reduce health-related costs coaching and disease management because of an and improve productivity and competitiveness. unrelated co-morbidity such as diabetes. Leveraging “A long-term strategy for corporate success must health and wellness programs across multiple include provisions for creating a company that benefits also improves the return on investment to supports, promotes and actively engages employees offset the cost of offering these initiatives. in achieving optimal health,” AAOHN stated. The association added that health promotion is Traditionally, employers would assess health “essential to a comprehensive healthful and safe insurance metrics (e.g., number of claims and work environment, which benefits the employer and average cost of claims) to determine which health the employee.” 1 and wellness programs affected benefit utilization

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and associated costs. A more holistic approach relies on health insurance metrics in a cross comparison, using absence management data and metrics to identify opportunities to reduce high utilization of healthcare benefits and absence programs such as short-term disability and Family and Medical Leave Act (FMLA). Integrated health and absence data also help employers identify opportunities to improve health and wellness by business unit, work location and job function. The more targeted interventions are to a specific employee population, the more effective programs can be in reducing risks as well as the costs and lost productivity associated with absences.

Taking a Team Approach An integrated approach to health, wellness and prevention requires teamwork, bringing together such disciplines as occupational health, disability management, human resources and benefits management. For example, disability managers contribute their expertise in return-to-work, which remains an important intervention for those employees who have become ill, injured or disabled, whether due to occupational or non-occupational causes. Returnto-work programs offer modified duties or temporary assignments to help employees ease back into the workplace after an illness or injury. The disability management approach requires both a clinical and an occupational knowledge base. In addition, the disability manager’s expertise is utilized in promoting prevention as well as stay-at-work, which allows employees to recuperate and heal on the job.

Occupational health clinicians are best equipped to assess medical conditions, responses to treatment plans and the appropriateness of temporary transitional work arrangements. Human resources and benefits administration provide their knowledge of leaves and programs. Other departments that may become involved include safety and risk management. A multidisciplinary approach allows each party to leverage its complementary knowledge and expertise across several programs with an emphasis on the employee--not the benefit plan that covers a particular absence. As employers and other stakeholders focus on the escalating cost of healthcare, wellness and prevention will continue to play a major role in reducing the incidence of injury and illness. A strategy of prevention will require more coordination among disciplines and leveraging of initiatives to support employee health by proactively preventing injuries and illnesses instead of only reacting to them.

Bio Lisa M. Scotton, RN, CCM, CDMS, COHN, is a Commissioner of the Certification of Disability Management Specialists Commission (www. CDMS.org), the only nationally accredited organization that certifies disability management specialists. She is also Clinical Best Practice Leader for Aon Hewitt’s HRO Point Solutions division.

REFERENCE: 1. American Association of Occupational Health Nurses, Inc., “Position Statement: Occupational and Environmental Health Nurses’ Role in Improving Employee Health and Productivity,” November 2006, www.AAOHN.org

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FEDS SET EXPLICIT GOAL TO ELIMINATE FEE FOR SERVICE IN SELF FUNDED PLANS by Stephen George

ederal reforms under the Patient Protection and Affordable Care Act (PPACA) and Centers for Medicaid Services (CMS) continue to regulate material change to the status quo. Federal Exchange plans at 24,500 members and growing slowly. Enrollments by state can be found at: http://www.healthcare.gov/news/factsheets/pcip06102011a.html

Centers for Medicare Innovation have stated their goal to eliminate fee-for-service medicine in 30 new Accountable Care Organizations (ACO). Noteworthy is a CMS stated goal of also directing same ACO’s into “population based reimbursement” or capitation for Part A and Part B medical expenses. CMS is explicitly directing selected ACO’s to also modify existing contracts with both Medicaid and Commercial Self funded medical populations. Several well organized medical centers are eagerly applying for ACO participation by deadline in August.

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CMS states, “The goal of population-based payment is to allow Pioneer ACOs the revenue flexibility to provide services not currently paid for under FFS, and to invest in infrastructure to support care coordination. This particular approach to population- based payment exposes the Pioneer ACO to the same level of financial risk as in the payment arrangement in the second performance period. The Innovation Center is open to testing a different form of population-based payment in the Alternative Payment Arrangement that would offer the Pioneer ACO greater levels of financial risk and reward.” For many metropolitan medical practices relying on Medicare (and eventually Medicaid), this means real change to the status quo. CMS is heavily targeting member assignment to experienced primary care physician patient management as their foundation to lower cost. CMS states, “Pioneer ACOs must commit to

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entering outcomes-based contracts with other purchasers (private health plans, state Medicaid agencies, and/or self-insured employers) such that the majority of the ACO’s total revenues (including from Medicare) will be derived from such arrangements, by the end of the second performance period in December 2013.” Merger or management of primary care function favors early adopters with clear vision, facilities and leadership. Many commercial and self funded plans are currently in place nationwide. Traditionally compensated fee-for-service medicine follows the practice of delivering care at disease onset with no payment for organized prevention. In a very real sense, we do not have health care plans, but we have disease care plans. The directly stated goal of converting entitlement reimbursement to capitation represents real change for doctors and hospitals who are unable to organize or manage the quality measurement standards mandated by CMS and ACO compliance. Primary care physicians have been complaining for years that the current feefor-service neglects to compensate wellnesscounseling that averts the very expensive and serious health attack. Capitated care is designed to pay doctors and their ancillary services personnel to stay in regular contact with higher risk patients and keep them healthy. Many have criticized inherent conflict of interest issues with fee-for-service payment; Conflicts that reward higher profits for unnecessary care. The capitated model represents a method to combat runaway medical expenses by rewarding physicians who are able to deliver care under a budget by keeping people healthy.

The philosophical position by some to declare capitation an incentive to restrict care for higher profits, must also claim the opposite position of fee-for-service incenting excessively prescribed procedures. The Federal Government has stated their belief in setting budgets, and ACO’s will deliver or lose up to 10-15% of total Part A and Part B reimbursements under one of five Pioneer ACO risk contract options. Where there is risk, there is potential reward. The upside bonus is shared savings of 50%-70% for managing care under the budget. “CMS will enter into Agreements with Pioneer ACOs only if they provide enforceable assurances that they can reimburse Medicare for all potential losses.” Stop loss works to reduce unpredictable budget shortfalls, and Provider Risk, LLC will be helping with this endeavor. Medicare spent about $528 Billion in 2010, and is projected to spend $1,038 BILLION by 2020. There is little question that benefits will be changing, along with the way CMS pays for care. CMS is clearly moving away from Fee For Service compensation as quickly as medical providers get organized and assume the budgeted program.

Bio Stephen George is CEO of Provider Risk, LLC. Specialists in Medical Stop Loss and reinsurance. reinsurance@providerrisk.com www.providerrisk.com

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by Les Meyer

ecessity Prompts Strategic Adaptation

Since maximizing resources for enhancing worker capacity and sustaining a competitive edge is more important than ever before, HR professionals need to become “people strategists” who are capable of aligning the workforce with key business objectives. One critical mission is to tame runaway employee health care costs, but industry practitioners have found that current methods no longer work. The next generation of solutions can be found in the

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notion of “value realization.” Success depends on insightful decision-making and problem solving, as well as an intuitive ability to lead their strategic business unit to create self-sustaining environments and support infrastructure wherein employees and their dependents consciously and subconsciously make healthier lifestyle choices. People strategists have a unique definition of value, which they consider the glue that galvanizes the workforce. In their view, value better aligns the interests of each organization’s leadership with employees to maximize

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individual peak performance for results that collectively improve a company’s bottom line. The bleeding edge of this thinking can be found in the C-Suite emergence of “disruptive innovation” (DI), a business term used to describe how a more nimble or entrepreneurial approach to creating value and sustaining a competitive advantage can disrupt certain markets.

focus on value-realization achievement. Key components will include high levels of sales, profits, customer satisfaction, production of high quality products, improved reputation and brand-equity status and business growth driven by the inextricable link between DI strategies and thriving wellbeing people action plans to sustain a competitive advantage. Strategic Business Process Improvement

People strategists understand the power and potential of creative execution and DI, which has a new application regarding how organizations can rethink many of the ageold assumptions about the human resources business model and deepen their investment in people through high-value workforce wellbeing initiatives. The DI mindset can be used to create “People Innovation Centers” that serve as an information clearinghouse for benchmarking the business of sustainability.

DI is the bedrock of strategic business process improvement (SBPI), an effective continuousinnovation approach to align processes with disciplined execution of an organization’s strategic goals to optimize underlying systems and structures to advance focused program integration convergence to achieve more efficient results.

People strategists strive to consistently match high-value workforce wellbeing designed to step up employee involvement in adopting healthier lifestyles with what is entrepreneurially and culturally feasible in the workplace. They know it’s not about employee behavior change. It is, in fact, about the wise health behaviors people embrace. People strategists are constantly looking for creative business models, real-world impact, farsighted risk taking opportunities and paradigm-busting execution. More importantly, they adeptly convert satisfied customer experiences, as well as valuable workforce investments and meaningful achievements, into corporate profits.

Clayton M. Christiansen, M.D., defines DI in “The Innovators Dilemma: When New Technologies Cause Great Firms to Fall” as: “innovation that transform an existing market or creates a new market through simplicity, convenience, accessibility or affordability.” To paraphrase his premise, DI is about profound change in the C-Suite. It is not just the magnitude of the advance. If it works to sustain the status quo, it is not disruptive. The key is a change in approach to one that better addresses critical business issues in the C-Suite and the demands to create and sustain “customer value.”

What’s different about DI leadership is that it moves from being an occasional episodic management by objective shortcoming to a breakthrough balanced measurement system achievement. It paves the way for the CEO to As CEOs continue to reconfigure HR seats create C-Suite solidarity and a united culture of in the C-Suite, they will be more inclined to innovation and comprehensive health promotion embrace business-centric people strategists to achievement in the company.

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People strategists judiciously converge on C-Suite leadership engagement techniques and incentive alignment SBPI action plans to precisely execute optimal measurement systems designed to determine gaps. This information is prioritized for a guided program planning and evaluation strategic roadmap to instate a sense of balance and achieve leading-edge best practices. A balanced view of the business requires continuous predictive data analytics for insight. Value realization of corporate benefits administration reporting in the C-Suite has not been meaningful, far-reaching or productive. Legacy benefits administration reporting is “aggregated” but not “integrated” and includes “data” versus actionable “information.” It also is not intelligible, accessible, consistent, precise, or reliable to the C-Suite.

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Susan R. Meisinger, former president and CEO of the Society for Human Resource Management and a board director for the National Academy of Human Resources, recently wondered: “Is it possible that we think we’re playing an important role in driving innovation in our organizations just because of how hard we’re working and not because we have any data to support that conclusion? Perhaps.” The time has come for a major paradigm shift that enables pioneering employers to simultaneously realize greater employee trust, talent engagement and customer value realization, as well as prevent spiraling health care costs and actually bend the trend. According to Kathleen Yeager, a senior professional human resources (SPHR) specialist

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and leading strategist on chief organizational effectiveness: “SBPI and DI spotlight creative execution and encourage organizations to focus on critical talent management [people] challenges and related ‘customer value realization’ issues and begin to embrace proactive constructive change in the HR operating model.” Profound change will not happen without constructive conflict. “The new value-centric HR professional who has a DI mindset would be an ideal role model and business leader in the C-Suite to promote the meaningful use of HR systematic performance improvement processes and best practices,” further states Yeager.

wellbeing fail to deal with DI and improving the business value of health in the C-Suite. People strategists understand and decode the inner workings of C-Suite critical thinking behaviors and linkage between employees, customers and profits by isolating perceptions and attitudes of health promotion investments and the business value of workforce wellbeing dividends that drive strategic SBPI business plans. Value realization encompasses several areas and requires relevant on-site, corporate level and company-wide reporting as defined by C-Suite leaders and front-line managers. What gets measured gets improved. The role of the people strategist is to determine what is important for the C-Suite team to measure. The undertaking is intended to rapidly shape and mold the SBPI process created to help pioneering employers answer:

It is clear that C-Suite distinctive competency discussions, recommendations and value realization optimization barriers cannot be tackled or resolved if there are no solid metrics to analyze and compare valuable 1. How are we doing employee engagement investments alongside (versus benchmark employers)? comprehensive culture-of-health programs that emphasize high-value workforce wellbeing 2. How can we improve (to the point to “bend the trend” on curtailing under the health promotion umbrella. employee health care costs)? Strategic productive advantage from comprehensive health promotion, high value workforce wellbeing improvements can be achieved only if understood and embraced at the C-Suite level. To achieve optimal engagement, people strategists have created next-generation SBPI C-Suite level benefits administration reporting dashboards and scorecards. Value realization materializes when action is taken on SBPI measurement insights.

3. What if ( involving simulation capabilities scenarios for planning and budgeting)?

An evidence-based measurement process provides the CEO with objective insight into comprehensive health promotion, high-value workforce wellbeing issues and processes. It also gives them the ability to objectively identify and help C-Suite leaders manage their company’s health risks, and provide an Cracking the Code early detection mechanism and feedback loop Many ideas aimed at improving comprehensive resolution option involving identified workforce health promotion, high value workforce well being problems.

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The Sustainability Imperative Keeping people healthy is a critical business strategy and serious economic imperative. People strategists are adapting in the C-Suite and getting down to business. They bring together thriving wellbeing people, as well as execute strategies and action plans that result in trust, engagement, incentive alignment, use of relevant information and distinct choices by the workforce. There is a strong consensus that sustainability related issues are having a significant impact on how people in the C-Suite think and act. Business is driven by value and value creation. No value? Then no sustainability. It’s that simple. But customer value cannot be effectively delivered without people strategists who recognize as their companies grow, they will need a SBPI system to continuously analyze, intertwine and refine their workforce engagement processes and high-value workforce wellbeing best practices. According to Michael E. Porter, Ph.D., a Harvard Business School professor and leading authority on competitive strategy: “Value — neither an abstract ideal nor a code for cost reduction — should define the framework for systematic performance improvement. Rigorous, disciplined measurement and improvement of value is the best way to drive system progress. Yet value remains largely unmeasured and misunderstood.” People strategists realize that measuring, reporting and benchmarking results are the most important steps toward rapidly improving company value streams to help CEOs make distinct choices about improving the bottom line and sustaining a competitive edge.

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The Importance of Critical Thinking in the C-Suite People are the biggest source of a sustainable competitive advantage. And people strategists realize that engaging, deploying and optimizing a fluid company-wide systems improvement initiative entails hard work. More importantly, the final step is to prepare a SBPI business plan that reinforces the company’s focus on DI and doing whatever is needed to go on delighting its customers. If you look at the most important issues for CEOs, they reveal the need for: 1) evidence-based, highvalue workforce wellbeing standards of practice; 2) proven high-touch, employee engagement (health behaviors) return on investments that are integrated with high-value workforce wellbeing results; 3) keen insights into comprehensive health promotion and neighborhood health assurance business models; 4) know-how to replicate ”experience curve” efficiency gains and bend-the-trend investment output effort; and 5) expertise of informed physician executive leaders as front-line people strategists whose integrated role enables them to be more effective and focused. Critical thinking is not driven by answers but by questions. The driving forces in the people strategists’ critical thinking process are the questions, which can lead to a better understanding of C-Suite leadership behaviors and how to create meaningful connections between employees and customers to achieve high profit margins. What are the secrets people strategists employ to command their CEO’s full attention? The answer can be found in six pointed questions to ask C-Suite executives in order to conform to the CEO’s reality (see Exhibit A).

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The CEOs C-Suite SBPI Survey Overview

current state and impact of company health care trends. The C-Suite survey tool was designed around commonly known leadership statistics, For more insight about the way to assess such as annual budgeted revenue growth. C-Suite awareness, knowledge and engagement in a comprehensive workforce wellbeing Nuggets of Perception Reveal program, consider the experience of a $15 C-Suite Realities billion multinational manufacturer with double digit annual health care cost trend This research process is based on a simple growth in self-insured plans. The entire senior premise, which is that an employerâ&#x20AC;&#x2122;s senior management team met with HR professionals management is critical in the development of during an annual leadership conference to focus an effective environment for improving workon business issues to sustain a competitive force wellbeing corporate cultures of health in edge. That effort required gauging the teamâ&#x20AC;&#x2122;s the C-Suite. Indeed, too few C-Suite executives awareness of employee health care issues and are aware that employee health care costs have the cost of that care. The hope was to elevate both a direct and indirect impact on profits or these concerns beyond the benefits department that workplace environment affects workforce and into the C-Suite. Another goal was to health care costs. The message to senior leadprovide an objective benchmarking tool to ers is that they can help reverse the health care track program progress internally and relative cost trend in their organization, but that they to other employers. The initiative was based on also cannot delegate this goal or accountability an optional multiple-choice, self-assessment to others. survey of senior manager awareness of the

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A small, albeit growing, number of employers are achieving flat or declining health care cost trends — considerable achievements that not only steer clear of short-sighted, costshifting strategies or benefit reductions, but also by expanding access to care in some cases where such a move is warranted. One common denominator among this elite group of organizations is how well their C-Suite scored on tests to gauge their knowledge of this topic.

only 20% were able to correctly determine how many full-time employee positions would have to be eliminated to cover those increases. Of those who incorrectly answered this question, 46% underestimated the number of positions that would be required. With regard to their company’s disability incidence rate, a mere 16% gave a correct answer. Of those who guessed wrong, all of them underestimated the actual rate and 63% picked a rate that was less than half of the correct answer. When asked to Key Research Findings describe the kind of health plan coverage their company offers, 40% gave answers that only fit The large manufacturer’s findings revealed a fully insured programs — the implication being steep learning curve among members of the that nearly half the senior management team leadership team, who did better at choosing the thinks that their health care costs are not direct right answers for traditional business questions business expenses. than workforce wellbeing. For example, only 38% of the 56 executives and front-line Perhaps equally egregious was the C-Suite’s managers who completed the questionnaire impression that the workforce was significantly answered correctly how much their company healthier than the reality of the company’s spent on health care, with 80% of those who situation. Asked to estimate the percentage of got it wrong underestimating that spending and covered lives considered to be well, at risk, more than half believing the figure was more chronic and catastrophic, 34% of the executives than 50% below the actual tab. did not even bother to answer this question. And of those who did answer, the average There were several other indicators showing a responses were 42% said employees were well serious lack of understanding. Just 34% were when, in fact, only 8% fell into this category. able to translate the number of incremental In addition, 32% believed there was more than cases of product required to cover expected one risk factor when, in fact, that number was annual employee health care cost increases and 70%, nearly 18% chose the chronic description,

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a close estimate to the actual 20% figure, and 6% said there were catastrophic illnesses in the workforce, whose number was 2%.

Teachable moments in the C-Suite may truly predict future bottom line profits. The disconnect revealed in the unique “C-Suite Active Engagement Survey” between Conclusion awareness and understanding of traditional C-Suite critical business issues and financial The DI SBPI decision-making process for key performance indicators is profound. Many strategic adaptation depends on a solid times the complete lack of understanding [and understanding of C-Suite attitudes, beliefs and engagement behaviors] in the C-Suite can be behavior patterns while improving the linkage brilliantly transformed into beautiful profits, for between employees, customers and profits. the very C-Suite engine that powers the business When members of the senior management team might just be HR. in a multinational manufacturer do not know key health care cost statistics for their business People strategists who embrace an HR or the fact that they’re self-insured, something application of DI along the road to attaining is seriously amiss in the C-Suite. Without a clear high-value workforce wellbeing will be able to understanding of how to stem rising employee help drive success in the C-Suite and reserve a health care costs and what is driving such permanent seat at the corporate leadership table. expenses in any given workforce, employers The secret weapon is a simple leadership survey that remain stuck in neutral on this issue will that HR practitioners can use to highlight this suffer a competitive disadvantage. issue in ways that garner much more support from senior leaders to engage in culture of Perhaps equally egregious was the C-Suite’s health solutions the same way they would in impression that the workforce was significantly other resource efficiency programs. healthier than the reality of the company’s situation. Asked to estimate the percentage of covered lives considered to be well, at risk, Les C. Meyer, MBA, is a chronic and catastrophic, 34% of the executives Dillon, Colo.–based health did not even bother to answer this question – care strategist and vice suggesting that they did not have a clue. And president of HealthNEXT, of those who did answer, the average responses senior fellow, Jefferson estimated that 42% of the covered lives when, in School of Population Health, fact, only 8% fell into this category. Collectively Thomas Jefferson University, chairman, they believed that 32% were at risk with more Informed Opinion Leadership Action Group than one risk factor when, in fact, that number (IOLAG): Employer Market Sector, board was 70%. (They were better able to gauge the member, Professional Patient Advocate chronically and catastrophically ill cohorts with Institute, and founder Taos Brain Injury figures of 18% and 6% while the actual figures Transitions Institute. He can be reached at 303were 20% and 2% respectively.) 916-0017 or Les.Meyer@HealthNEXT.com. Beauty is NOT in the eye of the beholder.

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Disease Prevention through Healthy Lifestyle Choices ~ Fitness and Proper Nutrition By Deborah MacArthur

he mere mention of the words cancer, heart disease and diabetes strikes fear in all of us. These and other disease can affect the young and old, strong and weak, male or female. There are studies, theories, and a multitude of proposed ideas on preventing diseases. New studies show that certain diseases can be prevented through healthier lifestyle choices, including regular exercise and a good nutritious diet. By taking care of the body through proper nutrition and being physically active, it is possible to help ward off mysterious and often fatal diseases.

increased body function, and better sleep and reduced fatigue. Research indicates that exercise can prevent certain diseases and cancers. Here is some food for thought: â&#x20AC;˘ Exercise reduces obesity, which has been noted as major factor in some forms of cancers and other diseases. Generally, people who exercise grow into other good lifestyle habits including eating healthier to stay fit.

â&#x20AC;˘ Exercise speeds up your metabolism, which helps flush out food waste and other harmful substances. Regular exercise offers numerous health benefits, These toxins travel at a faster rate through the including an improved sense of well being, digestive track, which decreases the time that the increased strength and flexibility, toned physique, colon tissue is exposed to waste and toxin.

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• Exercise helps to balance hormone levels, which are often linked to certain cancers. The female hormone estrogen seems to play a key role. Exercise lowers blood estrogen, which helps lower the risk of breast cancer. Exercise also reduces other cancer-growth factors such as insulin. • Dr. Inge Haunstrup Clemmensen, of the Danish Cancer Society, has theorized that regular exercise can boost the immune system, and having a strong immune system can stop the growth of cancer cells. Research by the American Cancer Society has indicated that an inactive lifestyle and poor diet are key factors to increased cancer risk, it becomeswhich makes imperative to add exercise into your daily schedule. Below are some suggested activities to engage in that will burn fat and boost metabolism. Keep in mind that the benefits of exercise increase as you increase the intensity: 1. Brisk walking: This can be done indoors on a treadmill, or outdoors around the neighborhood, or on a nature trail. 2. Yoga: A great stress reliever, as well as good physical activity. 3. Dancing: You can put some music on and dance at home in your living room, at a dance studio or at the health club. Zumba and other dance-based aerobic classes are popular offerings. 4. Swimming: Uses all muscles in the body and is a great cardio exercise, which is gentle on the joints. 5. Tai Chi: This form of martial arts promotes good health through controlled breathing and slow moving exercises.

7. Organize a team sport through your workplace: This is a great way to be active, get involved with co-workers and enjoy some healthy competition. These are just a few suggestions, but the message is that everyone needs to be active, get up and move! National activity guidelines suggest at least 30 minutes of exercise most days of the week. There are other small steps you can take to increase your level of activity. When you are at work, walk to your colleague’s office instead of picking up the phone or sending an email. Take a walk after lunch with your co-workers. Don’t take an elevator if you can take the stairs. Each day make a conscious effort to be active and make good choices. The other side of the healthy living coin is proper diet and nutrition. By making good food choices, you can build a strong and healthy body. The American Institute for Cancer Research (AICR), scientists believe a diet based predominately on

6. Cycling: Whether on a traditional or stationery bike, this is a great cardio exercise.

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There are a multitude of reasons to fit regular exercise and proper nutrition into your daily schedule. This is an area of your life that you have control over, and making the proper choice may save your life someday. Keep in mind that the choices you make each day regarding exercise and nutrition impact your chances of getting cancer. You can begin taking steps today to protect yourself against cancer, heart disease and other diseases. Many companies offer corporate wellness programs to provide the support and resources to their employees to make a healthier lifestyle a reality. If your company doesn’t offer a corporate wellness program, consider being an ambassador at your workplace. You can suggest initiating a wellness program to your human resources department or company management. Your efforts will not only benefit you, but they might be instrumental to affecting others to make healthier Below are recommendations regarding healthy lifestyle choices to prevent obesity, diseases, cancer lifestyle choices that will help prevent cancer from and maybe even save someone’s life. the AICR’s Expert report. These coincide with the recommendations from the American Cancer Society: plant-based foods may help protect against certain cancers. This type of diet includes vegetables, beans, fruit and whole grains. The fiber and water in plant foods gives a feeling of fullness without supplying a lot of calories. AICR recommends that two-thirds of your plate should be filled with vegetables, beans, fruit and whole grains, and one-third or less animal protein.

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1. Be as lean as possible without becoming underweight. 2. Be physically active for at least 30 minutes every day. 3.Avoid sugary drinks. Limit consumption of energy-dense foods. 4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans. 5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats. 6. If consumed at all, limit alcoholic drinks to two for men and one for women a day. 7. Limit consumption of salty foods and foods processed with salt (sodium). 8. Don’t use supplements to protect against cancer.

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Deborah MacArthur is the Director of Marketing and PR for FACTS Fitness, a Commercial and Corporate Fitness Management Company located near Philadelphia, PA. FACTS Fitness is a one stop fitness management company offering corporate wellness and fitness programming, fitness staffing, fitness center design, corporate fitness IT programming, multitenant fitness facilities and more. To learn more about FACTS Fitness services including corporate wellness programming, fitness management, fitness center design, etc. please visit www.factsfitness.com, email info@factsfitness. com or call 610-355-3236.

Self Funding Magazine

Diabetes and Its Effect on Future Employer Health Costs - Guidance for Employers By Jonathan Spero

iabetes is a disease caused by elevated blood sugar with medical complications, which are costly and devastating. According to the Centers for Disease Control and Prevention (CDC), the number of diabetics in the United States has grown to nearly 26 million, a 10 percent increase in the past 2 years.

So why are so many Americans developing pre-diabetes and diabetes?

The prevalence of diabetes is directly related to increased weight and age. With the epidemic of obesity, currently two-thirds of the U.S. population is either overweight or obese. In addition, the average age of the U.S. population is steadily getting higher secondary to people What is more alarming is that, according to living longer and the baby boom generation now the CDC, over 79 million adults in the U.S. are all above the age of 50. classified as pre-diabetic, a precursor of diabetes. This is a 33 percent increase in the past 2 years. How will this impact employers? According to the CDC, it is predicted that 25 to Well, it turns out that the cost of health care 33 percent of the U.S. adult population will have for people with diabetes is 230 percent more diabetes in 2050. (1,2,3) expensive than for people without diabetes

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Self Funding Magazine

according to the American Diabetes Association. (4) This statistic has been confirmed by a recent report from United Healthcare, which compiled data from 10 million members and found that the average annual health care costs in 2009 for a person with known diabetes were about $11,700 compared with about $4,400 for the non-diabetic public – 260 of this decade it is estimated that medical care for pre diabetes and diabetes will account for ten percent of the total healthcare spend in the U.S. Employers will bare a significant portion of this financial burden.

Why is care for diabetes so expensive? To start, the actual medical care required to treat diabetes is costly. Furthermore, the complications of diabetes are very serious and enormously expensive to treat. These conditions include heart disease, kidney disease, eye disease, nerve disease, and many other conditions.

available for employers to tackle all three. Let’s take a closer look at what these initiatives are and why all three are necessary. Screening - – Almost 30 percent of persons with diabetes are not aware they have it.(5) Therefore, screening for diabetes is critical to diagnose the large population of persons who are undiagnosed. Furthermore, screening also identifies the much larger population of persons with pre-diabetes, a precursor of diabetes. -Employers can screen their entire employee population for diabetes easily and inexpensively with a simple blood finger stick.

Prevention - – Modest weight loss achieved by lifestyle coaching can prevent persons with prediabetes from every developing diabetes. In fact, a large, nationally recognized study published in the prestigious New England Journal of Medicine demonstrated that achieving a modest 7% weight loss goal resulted in a 58 percent% reduction in So what can employers do to address the incidence of diabetes in a high-risk population this issue? that had pre-diabetes.(6) The solution for this issue requires a three-pronged -Employees with pre-diabetes must be encouraged approach – screening, prevention, and disease to enroll in diabetes prevention program with a management. The necessary tools are currently focus on proper nutrition and exercise.

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Self Funding Magazine

Disease Management - By all measures, that demonstrate a clear return on investment. diabetes is sub-optimally managed by physicians in the United States. Poorly controlled blood sugar and lack of routine maintenance care Jonathan Spero, MD, is leads to an accelerated risk of complications and CEO of InHouse Physicians increased healthcare costs. Several key diabetes and board certified in Internal studies have demonstrated that proper disease Medicine. Dr. Spero is an management intervention not only significantly expert in the field of targeted improves HEDIS scores but also reduces employee wellness programs healthcare claims for those patients enrolled in with measureable ROIs. the program. InHouse Physicians is a global employee health -Employers’ investments in diabetes disease and wellness provider delivering innovative management programs show promise in cost containment solutions to corporations delivering both short term and long-term health around the world. InHouse Physicians high and financial benefits. touch employee health services include a wide range of offerings such as cost effective In summary, diabetes is an epidemic that will worksite health centers, evidence based “predisease” wellness initiatives, health screenings significantly impact the cost of healthcare for plus analytics, flu vaccinations, and travel employers in the near future. There exists well medicine. thought out strategies for addressing this issue

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References 1. Narayan KM, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ: Impact of recent increase in incidence on future diabetes burden U.S., 2005-2050. Diabetes Care 2006, 29(9):2114-2116. 2. Magliano DJ, Shaw JE, Shortreed SM, Nusselder WJ, Liew D, Barr ELM, Zimmet PZ, Peeters A: Lifetime risk and projected population prevalence of diabetes. Diabetologia 2008, 51(12):2179-2186. 3. U.S. Census Bureau. National Population Projections Released 2008 (Based on Census 2000). 4. American Diabetes Association: Economic costs of diabetes in the U.S. in 2007. Diabetes Care 2008, 32:596-615. 5. 2005–2008 National Health and Nutrition Examination Survey. 6. Diabetes Prevention Program Research Group N England Journal of Medicine 2002; 346:393-403 February 7, 2002.

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