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TABLE OF CONTENTS
EDITORIAL Editor-in-Chief
Jonathan Edelheit
Assistant Editor Jenny Dodson
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A NEW WELLNESS INTERVENTION THAT CAN INCREASE CANCER SCREENING RATES FOR EMPLOYERS by Dr. Bruce Sherman and David Nikka
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TABLE OF CONTENTS
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LETTER FROM THE EDITOR
COMFORTABLE WITH HEALTHCARE REFORM by Jonathan Edelheit
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AVOIDING CANCER by Dr. Kathy Gruver
TO INCREASE YOUR ROI ON 03 HOW PREVENTIVE SERVICES, JUST IN TIME FOR HEALTHCARE REFORM by Peter Saravis
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HEALTHCARE: EAST OR WEST - WHO IS THE BEST? by Rajeev Mudumba
WILL THE HEALTH 13 WHAT INSURANCE MARKET LOOK LIKE IN 2020? by Tim DeRoche
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WHY PROPERTY & CASUALTY AND LIFE AND HEALTH PRODUCERS ARE TURNING TO LEGAL by Robert Heston
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EMPLOYER SPONSORED CANCER SCREENIN g
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LIFELONG LEARNING ACCOUNTS CASE STUDY by Jessica Trzyna
by Jonathan Spero
THE NEXT PHASE OF CDHP… AND WHAT REFORM OF HEALTHCARE IN THE UNITED STATES SHOULD BE… by Jerry Van Ness
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
COMFORTABLE WITH HEALTHCARE REFORM
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he dust is finally settling from healthcare reform. As an industry we are starting to see everyone understanding how healthcare reform works and will effect them and they are starting to get back to business as usual and moving forward. It is nice to see the industry no longer stuck on an uncertain future, not sure what direction to move in, or even to move at all because of how unsure they were about healthcare reform. Everyone has gotten into their post healthcare reform routine, and they are finally comfortable with it. Some may not be happy with it, they may not even like it, but they finally understand it and are moving forward accordingly. This is important, because our industry needs to move forward and not be stuck in time, or so focused on uncertainty that we are afraid to make decisions.
Jonathan Edelheit
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HOW TO INCREASE YOUR ROI ON PREVENTIVE SERVICES, JUST IN TIME FOR HEALTHCARE REFORM by Peter Saravis
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he healthcare reform legislation enacted this past spring, known as the 2010 Patient Protection and Affordable Care Act, requires new employer-sponsored health plans to fully cover employee preventive care services, with no out-of-pocket costs for workers. The coverage extends to all Level A and B services recommended by the U.S. Preventive Services Task Force, including cholesterol and blood sugar screenings, certain cancer screenings (such as mammograms and colonoscopies), as well as physician counseling for health issues such as obesity and tobacco cessation. As such, employees who previously may have had to pay a $10 or $20 co-payment for these services will now obtain them for free.
come at a better time. Americans are paying a heavy price for poor health choices and consequent health conditions that are preventable. Chronic conditions such as diabetes, heart disease, obesity and cancer not only contribute to a poorer quality of life, but are exacting a huge toll on our businesses and economy. Approximately 75 percent of today’s healthcare costs stem from preventable illnesses and chronic conditions, according to the Department of Health and Human Services.
Improving access to preventive care will result in earlier detection of potentially serious conditions, thus reducing chronic illness, hospitalizations, dependence on ongoing medications and emergency room visits, while enhancing quality of life. For employers, the potential benefits of moving in this The enactment of this legislation couldn’t have direction will include stabilized health insurance
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premiums and health costs, reduced employee Employee Engagement: Lessons absenteeism and presenteeism, and increased Learned productivity. Employers and health plans have been challenged In a perfect world, all of the pieces would fall neatly by employee engagement since the 1970s, but the into place and the Affordable Care Act would be a skyrocketing health costs and insurance premiums “win, win” for everyone. But, as with most things of the last decade caused many to redouble their in life, it’s not that simple. To suggest that cost is focus to find new and more effective methods for the only barrier standing between employees and increasing participation. healthcare engagement – and that health plan members will now flock to their physicians for all One of the most important lessons learned was that manner of annual checkups -- is wishful thinking, there is no “one size fits all” solution to member at best. health and wellness engagement. From that lesson sprang a bumper crop of new wellness strategies Over the last decade, many employer groups designed to meet the needs and engage the interests and health plans have experimented with free of a wide range of members. From spirited team preventive services. In fact, a 2009 survey by the health challenges to individual employee coaching National Business Group on health showed that to on-site health providers and sophisticated 73% of large companies surveyed were already Internet health management tools, employees have offering full coverage for preventive services, been bombarded with opportunities to get healthy with many also offering free or reduced costs and get happy. for mammographys, colonoscopies and other preventive procedures. Yet, despite these efforts Despite their many bells and whistles, most of these and the willingness from employers to foot-the- strategies have continued to produce a predictable bill, most workforces continued to see a low level result – they have primarily attracted the healthiest of employee participation. So much so that a segments of the employee population, which, by 2010 survey by the National Business Group on and large, are already self motivated and inspired Health reported that employers believe low levels to stay healthy. To everyone’s frustration, the least of employee engagement are the No. 1 obstacle to healthy employees – those who are overweight or improving employee health and reducing health smoke or don’t participate in a regular exercise costs. program -- have remained unengaged, unmotivated and unchanged. The message is clear. Unless businesses and health plans are able to engage employees and members In truth, there have been silver linings in health in preventive health programs in greater numbers, engagement strategies. For example, companies health care reform, wellness initiatives and the who have developed and implemented financial many other efforts at healthcare cost containment incentives with their wellness programs report may be little more than futile exercises. significantly higher participation in certain
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behavior management and health improvement programs. According to the NBGH survey, financial incentives ranging from as little as $51 to $100 can boost participation in smoking cessation and weight management programs and encourage workers to get biometric screenings.
effectively in tandem with financial rewards. Another solution that is gaining some traction but is considered controversial in most circles concerns a health mandate. Companies utilizing health mandates for preventive care can require workers to obtain specific preventive screenings, such as physicals, blood-pressure and blood-sugar tests, Pap smears, and mammograms over a specified period of time. Those who don’t comply within the time frame, and for years going forward, can be required to pay a higher premium.
But, participation in health risk appraisals is reported to require increased incentives, generally in the range of $100 or more. With many companies today facing shrinking margins and budget limitations, continuation of financial rewards may be difficult. The challenge companies how face is how to incorporate low cost strategies that replace or work Some benefits consultants say mandated benefits
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and other punitive health management programs are part of a growing trend. In a 2009 survey by Towers, Perrin, Forster & Crosby Inc., 45 percent of companies said they planned to, or were considering, adding penalties for employees who didn’t participate in wellness activities. But there are several huge concerns with mandated benefits. Labor leaders object to the idea of mandated health programs, and employers worry about the potential legal fallout. Some companies also worry that mandated health testing smacks too much of “Big Brother” and could damage the company image. For all these reasons, plus little hard-core evidence of the effectiveness of this approach, few groups care to walk this slippery slope. For the most part, employers prefer to use a carrot, not a stick, when it comes to health benefits. Still, employers fret that their ever-growing menu of health improvement programs and options devised to tantalize every type of personality is not
resonating with everyone. Why isn’t it working, and how do groups solve it?
What We Have Here is a Failure to Communicate Despite what may seem like an avalanche of employee communications about health in the form of emails, onsite posters, web sites and health events, many employees are simply tuned out, under-educated, ambivalent or overwhelmed by the healthcare maze. According to a recent study by the Midwest Business Group, a Chicago-based national coalition that represents many of the nation’s largest and most well-known employers, 56 percent of employees surveyed said they have “no motivation to stay healthy.” Even more telling, 88 percent of workers said they “lacked an understanding of the value of preventive services.” They do not know what
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preventive screenings they need, when they need them, where to get them, how much it will cost them, or why they should bother to get them in the first place. Clearly, what we have here is a failure to communicate. Employers and health plans have failed to connect the dots illustrating to employees how regular preventive screenings can detect health risks and conditions early, before they become lifetime chronic illnesses, like diabetes, or costly emergency health events like heart attacks or strokes. In addition, employers and health plans have failed to address deeper concerns, such as fear about what preventive screenings may find, anxieties about the types of testing that will be done, and feelings of shame or embarrassment associated with certain types of screenings. Another critical area that has not been adequately addressed in most health engagement strategies concerns time constraints and work-life balance. Many employees are overwhelmed both at work and at home, believing that they don’t have the luxury of carving out the two, three or four hours that might be required to visit a doctor’s office and get a checkup.
New Trends: Health Engagement 2.0 Though it may seem ironic, technology may ultimately be the solution that provides many members with the most personal and most relevant health engagement experience yet. That’s because the newest technology platforms allow businesses to collect and mine thousands of bits of real-time individual medical data, such as claims data, lab results, prescription purchases, health risk appraisals and health plan coverage, and then merge that data with the individual’s family, life-
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stage and behavioral attributes. Such “data profiles” can not only help to reveal current and potential health risks, but can help to predict future health behaviors and barriers to health engagement. These analytics can be merged with time-tested consumer and behavioral science applications to develop the types of highly personal and individualized communications that engage, educate and motivate employees to participate in preventive programs in a timely manner. This new approach, which has already shown remarkable results, is called “personal health messaging.” Personal health messaging and reminders can be delivered via direct mail to the home, email, telephone outreach or text messaging. On a very basic level, these messages inform employees of what screenings they need, when they need to have them completed, how to schedule an appointment, and what the cost will be. On a deeper level, messaging can be devised that addresses the member’s specific fears about the screening, can educate them about the screening, or can address scheduling, transportation or other concerns. They can even provide a sticky note reminder that members can affix to their appointment books or calendars! Most important they are personalized and customized – pressing the “hot buttons” of each individual in ways that motivate them to take action and understand why it is in their best interest to do so. Engagement communications can be used for early intervention, health improvement or disease management to get the right message to the member at the right time to produce the right result.
How New Engagement Technologies Increase ROI New health engagement technologies are already highly valued by early adopters for four reasons:
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1. Achieve Health Engagement Increases of 14-19 technology platforms that offer continuous Percent: Early studies of new health engagement technologies that utilize personalized messaging have found that they can increase employee adherence between 14 to 19 percent in the first year alone. For example, in a 2009 study funded by the Cancer Research Center, a reminder program aimed at early screening for breast cancer boosted mammography rates by more than 17 percentage points, according to results published in the American Journal of Preventive Medicine. The program used electronic health records to identify women who would soon be due for a mammogram and reached out to them via postcards, automated voice messages and personal phone calls. In early studies at Evive Health, employers also have achieved average employee engagement increases of around 17 percent. The program engages 100 percent of employees, with an opt out rate of less than ½ of 1 percent.
comparison testing of messaging campaigns, with the goal of continually increasing engagement. The best programs offer the ability to offer coordination of messaging with clinicians and other providers.
4. Measurable Outcomes A key tenant of new technology platforms is the ability to provide timely reporting and measurable outcomes that support the value and performance of the engagement program. Such reporting allows for companies to adjust their messaging to achieve better returns on investment.
The field of personal health messaging promises to take employee health engagement to a new level – just in time for healthcare reform. When offered as part of a comprehensive health management program, these new turnkey solutions can offer employers a vital tool to shrink health costs, boost 2. Low Costs of Implementation: New engagement productivity and make everyone a winner. technologies cost just pennies on the dollar to implement and require no investment in technology, infrastructure or time. The most cost-effective programs of this type offer per member per month Peter Saravis is the subscription options and include automatic upgrades founder and CEO of to the system as new versions are released. ROI ECHO Health, Inc. results can vary widely, depending on actual ability located in Cleveland, OH. of the vendor to measure increased avoidance or With over 30 years of early detection of costly conditions. In most cases, industry experience, he reported ROI ranges from $1.22:$1 to $4.3:$1, is recognized as a visionary and a pioneer depending on the methodology and time period. A in the application of technology in the credible preventive analysis must include the cost medical payment space. Prior to creating that self insured employers pay for significantly ECHO Health, Mr. Davis was the CEO increased utilization of tests and screenings. of Secure Solutions, where he developed anti-counterfeit processes for MasterCard 3. Easy to Integrate with Existing Preventive Care, International. Mr. Davis holds five U.S Wellness and DM Plans: Technology platforms are Patents and is a graduate from Ohio easy to integrate with existing health and wellness University. programs and utilize flexible and customizable
Bio
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HEALTHCARE: EAST OR WEST Self Funding Magazine
WHO IS THE
BEST? by Rajeev Mudumba
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bout 2 weeks ago, our dinner table conversation at home was around healthcare in general and the changing dynamics of U.S. healthcare as in many households in recent times. My 8 year old son turned towards me and asked, “Dad. Which country has the best healthcare in the world? Is it America?” That set me thinking… There are two schools of thought in the U.S. One, which believes that U.S. healthcare system is one of the better systems in the world or perhaps even the best and the other, believes we have a long way to go. If you turn on the TV or the radio, you will hear politicians out there telling you how the U.S. healthcare system is the best in the world irrespective of the escalating costs, myriad complexities of law, growing number of uninsured Americans, Medicare and Medicaid cuts and, if you, like me, tie quality of healthcare with longetivity statistics, U.S. placement as the 50th in a list of 229 countries for which it was tabulated[1]. U.S. healthcare has often been argued as one of the better systems based on some myopic stats such as lesser wait times for care compared to some of the other developed countries, better access to medical technology and vast majority of healthcare innovation happening in the U.S. The World Health Organization (WHO) conducted the first analysis to rank the world’s health systems in 2000. Using five performance indicators to measure health systems in 191 member states, it concluded that France provides the best overall 10
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healthcare followed among major countries by Italy, Spain, Oman, Austria and Japan. United States was a dismal 37th [2]. The five indicators were: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs). In other words, the quality of healthcare systems is based upon factors such as accessibility, affordability and the level of care and qualifications achieved by the professionals working within.
WHO compared each country’s healthcare system to upper limit of what can be done with the level of available resources in that country. It also compared each country’s healthcare system accomplishments with those of others. The WHO report concluded that health and wellbeing of people depend critically on the performance of the health systems that serve them. However, there is disparity in performance, even among countries with similar levels of income and health expenditure. Virtually all countries were underutilizing their available resources. The goal of the analysis was to provide a comparative guide to help countries learn from each other and thereby improve the performance of their health systems.
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In 2009 & 2010, The Commonwealth Fund conducted studies comparing the United States with about 10 other advanced nations through surveys of patients and doctors and analysis of other data. Its report ranked the United States on most measures of performance, including quality of care and access to it. The 2009 survey[3] concluded that there were wide differences across countries in access, healthcare technology, priorities and care quality. U.S. stands out for reporting cost-related access problems, lack of after-hours care, and lag in IT adoption. The 2010 survey[4] reflected cross-cutting themes and implications for U.S. Reform. United States stood out for access problems because of costs, difficulty paying medical bills, insurance complexity, and disparities by income. Symptoms of weaker primary care were seen in U.S., Canada, and Sweden. Germany, Switzerland, U.S., Netherlands and U.K. showed rapid access to specialists. Swiss were notable for rapid access to primary and specialized care. According to the survey, U.S. health reforms will make a difference. This includes many elements seen internationally such as premium assistance for low and modest income people; Medicaid expansion, Benefit standards with limits on out-of-pocket spending and Insurance exchanges and standards to reduce complexity. The Commonwealth Fund’s 2011 International
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Health Policy Survey is currently in progress. French medical care is deemed to be one of the best in the world. While it is true that you can get excellent care in France, it comes at a price. Individuals who are not French nationals pay extremely high rates while French nationals are taxed extremely heavily. That being said, France still has one of the longest life expectancies in Europe, with 81 years of age. The U.S. has been on the forefront of healthcare in terms of the % of GDP spent, innovation and cutting edge advancement in medical technology. We have produced the best of drugs and innovative surgery practices, but when it comes to making them economically viable for end consumers, we have miserably failed. From an economic perspective, such medical treatments are increasingly out of reach to many Americans. Healthcare costs are multiplying with each passing year, rising twice or faster than inflation and health insurance is getting to be out of reach for more Americans. There is a major disconnect between the progress made in health technology and its affordability for Americans. Healthcare as a fundamental right is an ongoing debate in the U.S. while most of the developed countries are already there, although they have their share of issues to contend with. Most of these developed countries have universal publicly funded healthcare. Not to say, that univer-
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sal healthcare is the silver bullet for healthcare woes, but it is an interesting point to note. World healthcare ranking may not be a true indicator of our quality of care in comparison to the rest of the world based on the subjective nature of these studies. But, with the U.S. leading the world in total spending; the question arises as to whether the quality of healthcare is comparable to the amount of money spent on that care. Studies have shown that some of the reasons for United States spending a larger percentage of its GDP on healthcare include higher labor, administrative and malpractice insurance costs. These studies; though subjective, do reflect that there are no particular areas in which U.S. healthcare quality is truly exceptional. Instead, the available data depicts that the US health system performance is a mixed bag, with the United States doing relatively well in some areas, such as cancer care and medical technology and less well in others such as mortality, accessibility etc. Although, the U.S.; like other countries has its own share of strengths and weaknesses in terms of the healthcare it imparts to its citizens; the value obtained for money spent on healthcare is drastically lower than the other countries. Important lessons can be drawn from countries doing better than the U.S. in various realms of healthcare. While US is a trendsetter in healthcare innovation and technology, these lessons will take it on the path of a true healthcare trendsetter in terms of providing efficient, accessible and quality healthcare to its citizens. The hope is that the healthcare reform (estimated to cost nearly $2 trillion over 10 years) will decrease healthcare costs and effectively proReferences:
1. The World Factbook - https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html 2. World Health Organization Assesses the World’s Health Systems - http://www.photius.com/rankings/who_world_health_ranks.html
vide millions with affordable insurance options. Health reform provides an opportunity for us to build on strengths, correct weaknesses and improve our framework. Perhaps, then, the U.S. healthcare system will improve quality and care statistics to measure up to other countries. The healthcare overhaul we have all been hearing about over the last couple of years underscores the need to take steps towards quality improvement; further, reform is needed to improve healthcare delivery, propagation of prevention over care, employment of technology and innovation to facilitate cutting edge health management, and help consumers demand focus on a health based economy than a sickness based economy which will pave the way for better health dynamics and make U.S. healthcare truly, “the best healthcare in the world.”
Bio Rajeev Mudumba works with a leading HRO/ Healthcare organization. Rajeev has over 16 years of leadership experience in the HRO, Healthcare and Technology consulting industries. His distinguished record of accomplishment and innovation includes high level strategy and ideation, precise execution and enhanced focus on efficiencies through the use of technology in business across various verticals. He can be contacted at rajeevsagar@gmail.com.
3. 2009 Commonwealth Fund International Health Policy Survey - http://www.commonwealthfund.org/Content/Surveys/2009/Nov/2009-CommonwealthFund-International-Health-Policy-Survey.aspx 4. 2010 Commonwealth Fund International Health Policy Survey - http://www.commonwealthfund.org/Content/Surveys/2010/Nov/2010-InternationalSurvey.aspx
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What will the health insurance market look like in 2020? Self Funding Magazine
by Tim DeRoche
FOUR SCENARIOS AND THE LAW OF UNINTENDED CONSEQUENCES
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f someone tells you they know how healthcare reform is going to impact the health insurance market, feel free to ignore them. From where we stand right now, it’s impossible to know what Americans’ health insurance will look like in 2020, even if healthcare reform is implemented in its current form. Projections by the respected Congressional Budget Office (CBO) suggest that reform may reduce the number of uninsured by 56% by 2019. The CBO projects that some employers will cut insurance, but millions of the previously uninsured will enroll in Medicaid or use subsidies to purchase insurance on the individual market.
billion, even if premiums are held constant in 2010 dollars.
Unfortunately, this base case will probably turn out to be wrong in significant ways. The law will almost certainly produce unintended This CBO base case suggests the individual consequences. But there is no way to know market for health insurance may grow by $80 with certainty what those consequences will be.
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Here are four possible scenarios:
The OPM plans, for example, will have the imprimatur of the US government and will be allowed to sell to consumers across state lines. If the OPM plans are able to offer better benefits and lower premiums, they may be able to achieve significant scale, which would further increase their competitive advantage.
Scenario #1 – The Rise of the Individual Market. We have an employer-based system because the government gives employers a tax deduction for premiums, making it economical for companies to buy insurance and pass the tax savings on to their employees. But the reform bill significantly undermines this economic tilt If most Americans feel comfortable with by providing subsidies to individuals who earn government-sponsored options, then employers will likely cut coverage, driving even more up to 400% of the national poverty line. people into these plans. It’s not hard to imagine If Americans respond to this shift in incentives, that this positive feedback loop could – over then the CBO base case may significantly decades – create a de facto public plan covering underestimate the disruption in the private the vast majority of Americans. market. Small employers – those with less than 51 employees – are not required to provide Scenario #3 – Much Ado About Nothing. In any insurance to their employees, and large this scenario, all the hullabaloo around reform employers can eliminate coverage by paying turns out to be just that. The typical American a paltry $2000 fine per employee. If there expects his or her employer to provide health are good options available on the individual insurance, and companies may have a difficult market, then employers of all sizes may dump time cutting coverage, even if the new law gives them the incentive to do so. their coverage. In this case, reform only impacts the health insurance market on the margin. The vast majority of Americans still receive coverage through their jobs, and the increase in Medicaid enrollment and the individual market is less than the CBO base case. Congress will likely repeal – or regulators will water down – any provisions of the bill that produce significant disruptions. HHS has already granted waivers to employers like McDonald’s who offer “minimed” plans that were supposed to be outlawed Scenario #2 – The Public Option in Disguise. by the bill. The bill provides for the creation of two Scenario #4 – Armageddon. The reform bill types of government-sponsored health plans: – and the CBO’s projections– are based on a the so-called CO-OPs and the Multistate delicate balance between coverage requirements Plans sponsored by the Office of Personnel for insurers and mandates on individuals. If the Management (OPM). These plans may have bill got this balance wrong, then prepare for significant advantages over traditional private possible doomsday. health plans. The American Action Forum – headed by a former director of the CBO – has calculated that the advantage of employer-based insurance may disappear for a family of four making less than $60 thousand, and up to 40 million Americans could shift to the individual market if employers and employees follow their economic interests. That could result in an individual market up to 5X as large as it is right now, and twice as large as the CBO projects for 2019.
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In this scenario, employers find it economical (and politically viable) to cut coverage. Healthy individuals, knowing they can’t be denied coverage, refuse to buy insurance until they get sick. The fines for being uninsured prove to be too small (or the government doesn’t enforce them). With a risk pool made up of the sick, insurers are forced to raise premiums, which causes even more individuals to drop coverage. The resulting negative feedback loop pushes insurers into a death spiral, and the government is forced to step in and bail them out. In the 1990’s, several states - including Kentucky, Maine, and Washington – passed laws requiring insurers to offer coverage to all comers (guaranteed issue) and limit price discrimination (community rating). In those states that didn’t have an effective individual mandate (like Massachusetts does), the individual market soon dried up, as healthy individuals declined to purchase coverage and
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insurers withdrew their offerings. In almost all these states, reforms had to be repealed. Of course, the law may be repealed, amended, or even overturned by the courts. But – even if it stands - no one knows what’s going to happen.
Bio Tim DeRoche is the founder and president of DeRoche Consulting Group, a boutique consultancy that specializes in strategy work for senior executives. He has previously written for the Washington Post, Education Week, and the Los Angeles Business Journal. tim@derocheconsulting. com
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WHY PROPERTY & CASUALTY AND LIFE AND HEALTH PRODUCERS ARE TURNING TO LEGAL PLANS? by Robert Heston
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he effects of the biggest recession since the 1930s spread throughout the economy and every community. At least 25 court systems face budget shortfalls.1 The depth of states’ funding deficits is substantial: New Hampshire suspended jury trials for a month, Utah is considering furloughing 1,000 court employees for 26 days, and New York has instituted a hiring freeze.2 Funding for civil legal services has also taken a substantial cut: the IOLA Fund, a fiduciary fund administered through the N.Y. State Comptroller that funds civil legal services, has indicated that it is in an unprecedented crisis. One state cut financial aid to Civil Legal Aid by an additional $2.2 million.3 Nationally, the unemployment rate more than doubled, increasing to 10.2 percent, with the number of unemployed now at 15.7 million.4 Historically, a rise in unemployment correlates directly with increased credit card use because credit cards become a means for consumers, particularly middle- and lower-class consumers, to pay for basic living and medical expenses—a purpose for which credit cards were not intended.5 The amount of credit card debt in the United States is startling. At the end of 2008, Americans’ credit card debt reached $972.73 billion; the average credit card debt per American household was $8,329. Seventyeight percent of American households had at least one credit card. In New York State, on average, individuals have 4.5 w w w. S e l f F u n d i n g M a g a z i n e . c o m
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credit cards; 14.8 percent of New York residents are using half or more of their credit. Unfortunately, a rise in unemployment also correlates directly with credit card default.6 Credit card defaults from this crisis, however, will probably not materialize into lawsuits for several years because credit card debt is typically resold many times before a plaintiff actually files suit. Moreover, creditors currently have up to six years to bring an action in New York for credit card default. Credit card defaults occurring now are likely to burden civil courts across the country for several years to come. Yet the time is ripe for change; governments, courts, advocates, and creditors alike are focused on the need for civil legal services and the problems faced by unrepresented litigants in consumer debt transactions and litigation. In
2010, U.S. employees faced more stressful issues than ever before given the extended and serious nature of this economy and this recession . . . . In this recession, 70% of U.S. employees need of some kind of legal advice, help or legal or financial representation to help them handle one or more of these legal a n d financial 18
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problems. The by-product that costs the employer each year in increased healthcare and emotional distress treatment and prescription drug costs is the effect of managing this serious amount of stress and the toll it takes on marriages and on children. Actual costs of employee stress related to legal and financial matters can be found in increased absenteeism and presenteeism, increased mistakes, accidents and injuries, and decreased work productivity. The real problem for employers is that when an employee has one or more of these major stressful legal and financial problems, it becomes the employer’s problem too.
Is My Agency Wasting Time Selling Legal? In a 2010 Univers study, 28% of employees in the companies surveyed had an employee legal plan – higher than the 19% who reported having homeowners and auto insurance at work. Perhaps not surprisingly, most employees who have a group legal plan tend to use it more than once (87%) and are more inclined to consult an attorney (2.5 times on average in the past five years) than those who found an attorney outside of work (two times). For at least one legal insurance plan, plan participants also re-enroll for the next calendar year at a high retention rate (93%). Compared to the commissions earned on certain life insurance products and health plans, the commission income for brokers and producers from ancillary products, such as vision, legal, and other types of products, can appear to be substantially less. For years, we have heard comments that suggest it “makes no sense to waste time selling other products, like legal,
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when the time could be spent selling the high production products.” We are all learning that in today’s solutions-based selling world, the producer or broker who can offer a cohesive or seamless solution to meet a specific employer need will get the business from that employer, regardless of size of company.
lawyers – with one exception – the ones that help you out of a problem, or to avoid a problem – often a large problem. Teenage children who are arrested for drinking and driving convictions can be excluded from professional schools and societies; school administrators unfairly target an “otherwise perfect student” with suspensions or expulsions hurting their chances of graduate degrees; businesses are able to freeze the bank accounts of a debtor and recover the $155,000 that debtor refused to pay for goods received from the business; foreclosure on a home mortgage 24 years paid-up is halted and the mortgage company’s mistake in payment allocation is finally clear in the litigation needed to prevent the foreclosure.
Because of the connection between legal and many of your “core” insurance products, legal can be an excellent tool to support the need and urgency for an agency’s “core” insurance products. Many producers/brokers are learning that simply by raising the concept of a legal plan, the sales techniques and approaches in a presentation can be increased dramatically, giving rise to “new” reasons for prospective buyers to purchase the core insurance products being sold. What are these techniques and approaches? Additionally, a spouse is able to thwart a court-ordered child visitation schedule preventing one spouse from spending What New Approaches to Selling time with their children after a divorce; Insurance Can Legal Bring? spouses can be arrested for non-compliance Raising the issue of a new product that with court-ordered child support payment “ABC Company needs to look at” is one of schedules; elder parents can unknowingly the most effective sales presentations. If the spend-down their entire estate so one spouse product is exciting and needed, because it is can receive the nursing home care they need, new, it is likely to peak one’s curiosity, and leaving the other spouse virtually penniless; using a new product to raise new solutions and the parents of a college student can present a very compelling value-based face a huge lawsuit because their child sales story to a company. The problem with paralyzed a 6-year old girl in a car accident. using Legal in this manner is that it can be viewed negatively and may be a topic about Notice the magnitude and importance of which few people want to actually discuss. many of these life situations requiring solutions can be for businesses and But, without even fully understanding legal consumers. You might also notice how many issues, all employers and most adults can core insurance products solve, or prevent, relate to the pressures, costs, uneasiness, the same magnitude of life’s problems – life unpredictability, uncertainty and enigmatic insurance can be the difference between legal system. Many would agree that the prosperity and poverty – disability insurance United States would be better off without can be the difference between keeping
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one’s possessions and losing everything. reasons why a life, disability or LTC product should be purchased. To do this, one must The Sales Value of Legal – “Making understand how legal issues and problems can the Connection” ruin businesses and consumers, how much they can cost, what a legal plan can save a In simple terms, legal has the same purpose business or consumer and whether legal plans as life insurance, disability, long-term care, can truly prevent legal problem-a task too and the new supplemental medical policies – large for this article, but at least we can raise the protection of what one has worked for and certain issues for more detailed discussion. accumulated. If the themes are the same, it makes sense to use these themes to raise the prospect Understanding the Sales Value of of additional threatening legal issues that can Legal Issues highlight the need for all of the protections you offer. Themes like avoiding foreclosure, In enrollment, one should seek to position a repossession, frozen bank accounts, judgments, legal plan as a solution that provides strategic collections, attachment of savings accounts, value to each Plan Member and their family. along with preventing lawsuits can resonate To compete effectively with a value-based with employers and employees. Additionally, sales formula requires that producers/brokers/ being prepared for Medicare issues, planning enrollers understand the critical success for elder parents, and children away at college factors of the potential purchaser, and deliver are all themes that easily lead into sales of a a strategic solution that ties valuable protection producer/broker’s core insurance products. benefits to those issues. Using an analysis of These themes can be connected with the the true costs of the American Legal System,
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and combining this analysis with an innovative new solution-oriented program that Plan Members may not have, all in an affordable package, provides the critical success factors that are vital to the success of an enrollment.
Benefits to the Producer – “Using the Legal Connection” The Connection Between Legal and Your Core Products
might offer up to 35% level commission. So for example, if a group has 780 employees [assume 44% penetration, that is 343 Plan Members enroll] and the combined employee legal product is sold, with a 35% commission the commission income to the broker is $ 1,680.70 per month. [35% of 343 x $14.00/ month = $1,680.70/month or $20,168.40/ year to the producer/enroller – for one group].
Indirect Commissions from Your Other “Core” Products Using Legal The combination of Legal and your existing -“Making the Connection”
worksite solutions can provide significant financial benefits for any enrollment. Packaged Using legal can help you in at least two (2) with additional worksite products, the right legal ways: (1) keeping your client company and plan can add commission dollars in two ways: not losing them to another benefits specialist, because you can meet their request for a • Significant Direct Commissions. legal plan; and (2) using legal to “make a connection” between legal issues and core • Increased Indirect Commissions from issues that help sell products like life insurance, Other Products. long-term care or disability can add new employees for these core products because Direct Commissions from Legal the legal plan resonated with that employee. When you use legal to raise issues that Commission structures and compensation help sell other products, it is important to for brokers/produces/enrollers can vary understand the connection and perhaps to widely. Many plans offer very attractive have these issues properly identified for the compensation programs, particularly with client company or the employee before the producers that have an interest in selling Legal. sale. Recall that we discussed certain critical Depending upon the legal plans, a legal plan
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legal issues that are related to your other enrollment, one can also tie the concept of insurance products. Several examples of the Life Insurance to the employee concern about more critical “connected” issues include: being protected while living. We have found that while many Americans know they need • Probate/Will/Trust/Estate Planning Issues a will, they do not get one despite the feeling and the Life Insurance Solution that they should. This same hesitation occurs with Life Insurance, as most Americans know • Workers Compensation/Injuries/Driving they need to have life insurance. Both concepts Suspensions related to Disability Products raise the issue of taking care of one’s affairs at the time of death and there are some employees One Selling Example: Probate/Will/ that simply do not want to deal with that issue.
Trust/Estate Planning Issues
The relationship between death and securing the protection afforded by Life Insurance is obvious, as is the relationship of using Life Insurance as an estate planning vehicle. Using Life Insurance to cover the expenses of one’s estate at death has also become a well-developed insurance sales tool. Are there connections between legal issues and life insurance? Yes, including the concern of dying without a will, and having one’s property “go to the state” rather than to one’s heirs, a situation that can often be remedied with a will and a life insurance policy. A different approach can be used by raising the concept of preparing a Medical Directives, or Living Will [also known as a Durable Power of Attorney]. By raising the possible need for a Living Will with an employee during
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Using the Living Will concern can bring an entirely new approach to this subject, as a Living Will is designed to protect one while they are living in the event of a serious illness or potential serious surgery. We have learned that the concern about death is often not part of the consideration in discussing the need for a Living Will, thus alleviating the “I will get to it later” mentality encountered during enrollment. Instead, by raising the concern that an employee may not have enough protection in place without a Living Will, the discussion during enrollment, centers on taking steps to prepare for events that can happen now. This focuses the sales discussion on the “not enough protection in place now” concept. Once that issue is raised, you can easily solve the Living Will Problem by offering a legal plan that
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covers a Living Will. In addition, this solutionbased discussion then enables you to make the connection to life insurance that should be in place now. By changing the focus of the purchase to smaller scale events that need to be addressed now, the life insurance sale can be changed from a concern about “when I might die” to a concern about “planning all the ‘little things’ to be in place in case of the unexpected.” Interestingly, this same argument also can raise the connection to a disability insurance policy.
Increased Revenues from Increased Sales Whether you are selling a Life policy or you are in P&C sales, using the legal angle to enhance the combined worksite solution value can result in an additional revenue stream for a producer/broker/enroller.
Using these legal issues in this new light to raise the issues solved by your core products is a technique that can result in new sales from Workers Compensation/Injuries/ employees who may not have been exposed to Driving Suspensions this new approach. This different light can raise the concerns that may hit the “hot buttons” for Similarly, using the concern that the strapped which employees know they need protection. workers compensation system may not pay enough if one is injured at work to heighten the need for disability insurance is commonplace today. Using a different angle, however, might Robert L. Heston, Jr., President and CEO of heighten disability insurance sales. Producers the Legal Access Companies, has more than 28 can raise the legal issue of whether an employee years of legal plan administration and law firm who needs to drive as part of their work [as management experience. His area of expertise an example] has been concerned about being is client-driven service excellence practices injured while driving, or having their license and integrated legal plan sales strategies that suspended or revoked. Certain legal plans increase the reach and value of legal services provide coverage for these events and can provided to employees and legal plan members help to prevent suspensions or revocations, worldwide. Legal Access’ newest focus is on in some cases, by providing legal advice and developing a specialized technology platform lawyers to represent employees on traffic that can be used by producers/brokers/enrollers tickets, suspension hearings and related matters. to sell legal plans in a cost-effective and efficient manner. The Company specializes in Raising the issue of injuries from accidents or working with producers on a one-to-one basis suspensions/revocations of one’s license can to achieve significant penetration levels for raise the issue of the possibility of losing one’s worksite products. For more information, visit job or being out of work for an extended period www.legalaccessplans.com, or call of time. By raising this issue, employees can also 1-800-562-2929 or Robert can be reached at readily see the need for disability insurance, albeit bob_heston@legalaccessplans.com. in a new light using a different sales approach.
Bio
1 John Gramlich, Court Cuts Trigger Blunt Warnings, Stateline, Feb. 18, 2009, available at http://www.pretrial. org/Docs/Documents/Court%20cuts%20trigger%20blunt%20warnings.pdf. 2 Id. 3 Legal Aid Society, Cuts in City and State Funds for 2010 Will Further Impair Legal Aid’s Ability to Provide a Constitutional Defense, Feb. 4, 2009, available at http://www.legal-aid.org/en/mediaandpublicinformation/inthenews/cutsincityandstatefundsfor2010willfurtherimpairlegalaidsabilitytoprovideaconstitutionaldefense.aspx.
4 Bureau of Labor Statistics, Economic Situation Summary, Nov. 6, 2009, available at http://www.bls.gov/news. release/empsit.nr0.htm. 5 Robert W. Murphy, “Taming the Collection Tempest”:A Primer on Federal and State Restraints on Consumer Debt Collection, Practising Law Institute Seminar (Mar. 26, 2009). 6 Juan Lagorio, Capital One Credit Card Defaults Rise in September, Reuters (Lisa Von Ahn ed.), Oct. 15, 2009, available at http://www.reuters.com/article/businessNews/idUSTRE59E25820091015.
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THE NEXT PHASE OF CDHP…
AND WHAT REFORM OF HEALTHCARE IN THE UNITED STATES SHOULD BE…
by Jerry Van Ness
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ack at the advent of PPOs, health insurance deductibles were extremely low, the insured covered by a group health plan had very little out-of-pocket liability, and the cost for a group health plan was a fraction of what it is today in relative dollars. So, what happened to this concept and just where did things go so wrong? Why is that in the era before group health plans and managed care that medical services were so readily available and relatively inexpensive? In this author’s opinion, there are three major reasons for our healthcare debacle: provider abuse of the system; ridiculous judgments by our judicial system and government intervention in general; and finally, but just as important to the financial sustainability of our healthcare system, the lack of financial responsibility of the patient. After the insured has met their deductible and out-of-pocket maximum, providers are many times free to do whatever they want by continuing to provide the patient with services that are of “medical necessity” in their judgment. For the most part, the services that are recommended by the provider are accepted by the patient without much question, partially because the patient has no further financial responsibility. “Who cares? The insurance company will pay for it” was, and still is, the prevailing attitude among those who have met their out-of-pocket responsibilities. This problem is obviously going to escalate with the continued decrease in patient responsibilities under healthcare reform. Sprinkle in the ridiculous judgments of our judicial system that have been raising malpractice insurance rates and other provider liabilities over the years, toss in the fact that after meeting deductibles and out-of-pocket maximums patient’s have no incentive to make sound financial decisions on their treatment,
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and there you have it…a system out of control! These reasons, my esteemed colleagues, are THE fundamental problems with our healthcare delivery system, NOT the insurance carriers making too much money and having no competition. (Are you kidding me Mr. Obama? No competition? Then why don’t you have our government investing in the health insurance companies? And by the way, did you happen to mention to the American public that the majority of employees covered under group plans are actually self-insured by the employer, so there is no insurance carrier reaping the benefits?). Have you noticed how hospital systems all over this country are growing by leaps and bounds? THEY are the ones making most of the money in our healthcare delivery system. I can tell you that my health insurance company stocks are most certainly not! Okay...I’ll step down from my anti-PPACA soapbox and get back to topic, employeepaid benefits. So, just what should we do if employers still wish to provide valued benefits to their employees AND effectively control costs? There is a unique and simple solution that bundles the high-deductible “ConsumerDirected” concept (i.e. the insured taking more financial responsibility for their healthcare decisions) and combines it with a voluntary supplemental, $0 deductible defined benefit health plan that will cover the most frequently utilized healthcare services (Phys. Office Visits,
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high-deductible to cover large claims, and the employee would pay for the underlying limited medical coverage if they would like coverage for routine and maintenance services – but only if they want it. The employer has the option to design a major medical plan that would have a deductible of $5,000, $10,000 or maybe $15,000, depending on their budget and risk appetite. Employees, in turn, are offered several different levels of first-dollar limited medical plans (fixed-indemnity that are not subject to PPACA regulations) that will cover most routine and essential services that fall underneath the high deductible amount. This underlying coverage can be entirely employee paid (and pre-tax), employer paid, or a combination thereof (e.g. the employer might pay for a lower level limited medical plans and offer the employee a buy-up).
Diagnostics and Rx), and for a relatively nominal cost. The cost for this “first layer” of fixedindemnity limited medical coverage averages about $100 per single employee per month.
In one case example, a group provides a major medical plan that has a single employee deductible of $10,000, and is willing to take some risk and purchases reinsurance over a specific deductible of $75,000, and also provides a defined benefit limited medical plan that will generally pay about 85% of expenses incurred below the deductible level, the TOTAL cost for this plan would average about $225/single employee/mo. Due to budgetary constraints, if the employer wants to make the underlying fixed-indemnity medical plan entirely voluntary, their share of that cost would be less than half of that $225/month! (In addition to the self-funded risk, of course). If the employer does not wish to take any risk, and fully insure the high deductible, average savings are still substantial.
This Defined Benefit + Stop-Loss model is being dubbed by its creators as the “Benefit Partnership” concept. The basic idea behind the model is to create a healthcare partnership between the employer and its employees. Since employee contributions are continuing to increase as their employer needs to continue to shift costs to manage rate increases, the basic premise of employees sharing in the cost of insurance will be nothing new and unreasonable to most This two-pronged approach is a tremendously employees. The “partnership” is created in that cost-effective solution, which after routine the employer will absorb the entire cost of the w w w. S e l f F u n d i n g M a g a z i n e . c o m
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services, transfers some financial responsibility to the insured so that they will be motivated to “shop” for their services and not abuse the insurance plan – especially considering the defined benefit structure of the underlying limited medical plan. Therefore, the “GAP” in coverage is between the first-dollar limited medical coverage and the high deductible plan, but this would generally be comparable to a gap at the front-end of a high-deductible plan in terms of overall exposure. But the key advantage with this model is that the majority of the time, the first-dollar limited medical coverage eliminates most of the out-of-pocket costs for the insured. Perfect! This concept is truly a Win-Win for the employer and its employees, and can also be a win for the savvy broker or consultant that is willing to think outside the box. This concept is truly a method to better ensure the economic sustainability of group healthcare in
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the United States. Economic sustainability is where our government should be focusing its “reform” initiatives – just as the private sector is forced to do to ensure its survival. That is unless it gets bailed-out by the government… that is the taxpayers and consumers of goods and services sold in this country.
Bio Jerry Van Ness is the Director of Sales for The American Worker Plans, Inc. In his 20 years of experience in benefits he has represented several leading group insurers of all types of health & welfare products and administrative services, retail benefits consulting, and risk management at the employer level. He can be reached at Jerry@ TheAmericanWorker.com or 866-215-9300.
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A NEW WELLNESS INTERVENTION THAT CAN INCREASE CANCER SCREENING RATES FOR EMPLOYERS by Dr. Bruce Sherman and David Nikka
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s a component of corporate wellness programs, cancer screening provides one of the most direct and immediate health benefits. It requires only simple testing versus long term, sustained behavior modification and there is significant clinical and economic value in catching cancer early in its most treatable stage. As such, cancer screening has been an important benefit design consideration for employers for a number of years. Yet despite efforts to increase use of recommended screening tests, participation rates have been less than ideal, such that the benefit of this valuable wellness component has not been fully realized. In this article, we report on the results from a pilot of an innovative, cost-effective program that has the potential to significantly increase cancer
screening rates for employers.
Why Early Cancer Detection is a Vital Wellness Issue Most cancers have few symptoms in their early stages. In general, symptoms don’t appear until the cancer has grown and perhaps spread, when the cancer is more difficult to treat. However, the outlook for cancer survival and even cure can be very good if cancers are diagnosed early in their most treatable stage (Figure 1). This is why many organizations have promoted the use of and compliance with cancer screening guidelines, including those from the US Preventive Services Task Force, the American Cancer Society, and numerous physician specialty organizations.
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Figure 1. 5 Year Cancer Relative Survival Rates by Stage at Detection
Cancer
Early Stage
Late Stage
Breast
99%
23%
Prostate
100%
29%
Cervical
91%
19%
Colorectal
90%
12%
While diagnosing cancer early improves survival odds, it also reduces metastatic disease and the costs and morbidity associated with chemo/radiation therapy and necessary surgical treatment. Cancer has been reported to be the leading cause of longterm disability and the second leading cause of intermittent short-term disability for U.S. employers (Figure 2).
National Cancer Institute, Seer Stat Fact Sheets, accessed 5/2011
Figure 2.
Most Frequent Disabling Conditions Early detection of cancer provides the opportunity for curative treatment and can minimize the significant healthcare expense of latestage disease. The cost of treatment in the last year of life for cancer patients under the age of 65 who die of breast, cervical, prostate or colorectal cancer ranges from $93,000 to $129,000 (Figure 3).
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Figure 3. Annual Cost of Care for Selected Cancers vs. Other Causes
Mariott A, et al, Projections of the Cost of Cancer Care in the United States: 2010–2020. JNCI 2011; 103:2
Figure 4. Aggregate Drug Cost for Metastatic Colorectal Cancer Treatment
The CEO Roundtable on Cancer reports that companies spend on average $3,000 in direct annual medical costs for employees without cancer vs. $16,000 for those with cancer. The National Business Group on Health states that the cost of cancer treatment is typically among the top three most costly conditions representing on average 12% of total medical expenses. The cost of late stage cancer care is also rising. For example, according to the Colon Cancer Alliance, the cost of early diagnosis of colon cancer is about $30,000. In contrast, the treatment cost for delayed diagnosis ranges from $120,000 or more with newer available treatment options. This is largely a result of chemotherapy costs, which have risen by as much as 800% between 1996 and 2007 (Figure 4).
Adapted from: Meropol N, Schulman. Cost of Cancer Care: Issues and Implications, J Clin Oncol 2007;25:180-186.
Current Status of Cancer Screening mammography. Depending on health benefits costs and access to care, screening rates for Colorectal cancer screening has perhaps the individual employers are often even lower. lowest participation rate of all screening tests, with nationally reported compliance rates In an effort to promote cancer screening, many of 54%, according to the Healthy People employers have eliminated out-of-pocket costs 2020 website (http://www.healthypeople. for screening tests; healthcare reform legislation gov/2020/topicsobjectives2020/objectiveslist. incorporates such first-dollar coverage as well. aspx?topicid=5). Approximately one-third This removes the financial barrier for employees of all women still do not receive annual to seek screening, but doesn’t necessarily
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motivate them to get screened. Other factors that contribute to low cancer screening rates include lack of understanding the relative importance and value of cancer screening, perceptions regarding the testing process and options, as well as access and convenience concerns.
The telephonic intervention was provided by ScreenCancer, Inc. which utilizes an outbound call-center approach and comprehensive, tailored algorithms optimized for individual healthcare conversations. The service provided assessment, education, test facilitation when requested, and follow-up to maximize completion of recommended testing. A Midwest Employer Study dedicated call center Navigator was assigned It is not difficult to appreciate that from an to each participant throughout the program. employer perspective, regular participation of Cancers included in the screening program were employees and family members in recommended breast, cervical, prostate and colorectal. cancer screening represents a source of value. While employers may be aware of low Participants were contacted at home at times compliance with one or more cancer screenings, selected during enrollment. The initial call began few options have been available to meaningfully with a review of each individual’s personal risk increase screening rates. Recently, an innovative factors and screening history. Depending on approach to increase cancer screening rates has the information obtained, targeted educational been developed using individualized telephonic information was provided along with a decision support. Our study, described below, discussion of appropriate screening options. evaluates the effectiveness of this program in an For colorectal cancer, colonoscopy was stressed employer setting. as the best option (and the only option for those at increased risk). If participants did not want colonoscopy, they were offered the option of Methods Employees and spouses aged 50 or older of an at-home fecal immunochemical test (FIT) a county government in the Midwest were sent directly to them. Initial calls ranged from given the opportunity to participate in a novel 10-15 minutes, and participants received up to telephonic health outreach program designed three follow-up calls to answer questions and to increase compliance with recommended track and encourage completion of testing. The cancer screening guidelines. The program was program ran for four months from the start of voluntary and communicated to employees enrollment through the last call. by mail, email, benefits meetings and was an offering at an annual health fair. Individuals Results could enroll onsite, by phone or on a dedicated One hundred twenty eight individuals signed up website. The existing employer self- for the program, with 12 not responding to initial insured health benefits design had, for some outreach communications. Of the remaining time, provided first-dollar coverage for all 116, 68 (59%) were already compliant with all recommended screening tests, so no financial recommended cancer screening, leaving 48 (19 barrier existed to individual compliance with males and 29 females) who were due or past testing. due for preventive care services, as shown in
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Figure 5. At the end of the program, 31 (65%) of these individuals successfully completed all of their recommended cancer screening services, bringing the overall compliance of the group to 85%. The effectiveness of the ScreenCancer Navigator™ approach in increasing compliance with screening for specific cancer types is shown in Figure 6. Of the different types listed, compliance with recommended colorectal cancer screening demonstrated the largest increase, with a 27% relative improvement in overall screening compliance and a post-program compliance rate of 87%, well above the national average of 54% (Healthy People 2020).
Figure 5. Pre and Post-Program Compliance with All Recommended Cancer Screenings
Figure 6. Pre and Post-Program Compliance with Recommended Screening by Cancer Type
A post-program survey was also conducted where participants were asked to rate their experience with the program on a scale of 1-5 (5 highest). The overall satisfaction rating was 4 out 5 with the results of individual
Figure 7. Pre and Post-Program Compliance with Recommended Screening by Cancer Type
Discussion Existing communication and education strategies to promote cancer screening have helped to increase awareness and understanding of the value of testing and early diagnosis, yet overall screening rates remain less than optimal. The recently released Healthy People 2020 goals include a targeted colon cancer screening rate of 70.5% among adults aged 50-75 years, and increases of 10% for both breast and cervical cancer screening rates. The program used in this pilot is based on methods which have been shown to increase cancer screening in other settings. These include a study of more than 1400 patients enrolled in a one-on-one patient education program similar to the ScreenCancer Navigator that found patient adherence with prescribed use of a molecular colorectal cancer test increased from 29% to 73% (Bagshaw J, Bucher W, Am J Gastroenterology, 2006;101:S549). Other studies including variations of telephone outreach to increase compliance also show significant increase in cancer screening rates vs. control groups. The approach used in this pilot was shown to be efficient at increasing cancer screening rates, likely due the use of a cancer-focused staff utilizing computerized decision-support algorithms and tracking capabilities. This efficiency also allows for a low per-enrollee cost. Depending of the size of the company, the cost savings resulting
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from just diagnosing and treating one cancer at an early stage relative to delayed diagnosis may well cover the related program costs. Targeting only known non-compliant populations (established through HRAs, claims analysis, etc.) could further enhance cost-effectiveness. While the results obtained are significant, there are limitations of the pilot that deserve mention. First, program participants represent a self-selected subset of the entire employee population. As a result, these individuals may well have been more receptive to changing their use of cancer screening services. It is unclear how other individuals who did not elect to participate in the program would have responded to a similar intervention. Secondly, the enrolled population had a higher baseline compliance rate with cancer screening relative to national benchmarks. However, even with higher baseline compliance, the observed increase in colorectal cancer screening compliance in particular was significant. It should also be noted that while the program stressed colonoscopy as the best and primary option for enrollees who where non-compliant with colorectal cancer screening, many people elected to perform a FIT test instead with the understanding they would be testing annually (Figure 8). A FIT test, also in recommended screening guidelines if done annually, it is a test collected at home and then mailed to a testing laboratory to check for the presence of fecal blood, potentially indicative of cancer. When requested by the participant, the program provided FIT test education, ordering, tracking, follow-up and reporting to both the participant and their physician. This likely accounts for the high compliance rates for this test when compared to previously reported results.
Conclusion This pilot study has shown that significant increases
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Figure 8. Colorectal Cancer Screening Test Utilization
1 Insure FIT, Quest Diagnostics
in individual participation in cancer screening, and in particular for colon cancer, can be attained using personalized and efficient telephonic decision support. Based on these results and data from other studies, employers with less than desired compliance with preventive care services may want to consider adopting a similar technique to increase screening participation rates. Broader use of this approach will help to clarify the value to both employers and eligible individuals.
Bio Bruce Sherman, MD, FCCP, FACOEM, is Director, Health & Productivity Initiatives with the Employers Health Coalition of Ohio, providing claims data analytics and health management strategies to employer members. Dr. Sherman is also consulting Corporate Medical Director, Whirlpool Corporation supporting the development of integrated, value-based health and productivity management strategies. David Nikka is CEO of ScreenCancer, Inc. a company that provides programs to costeffectively and significantly increase cancer screening rates for employers, insurers and other target populations. David has over 20 years of experience in healthcare, biotechnology, medical devices and human resources and can be reached at 339223-0573 or dnikka@screencancer.com.
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AVOIDING
CANCER by Dr. Kathy Gruver
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here are certain phrases that people dread hearing in their lifetime, “Let’s just be friends”, “We have to talk” and “You have cancer”. The last phrase can instill fear and panic in the hearts of even the strongest people. Since the war on cancer began things have only gotten worse and you may wonder if modern medicine has the weapons needed to fight the war properly. Perhaps the mêlée should be fought on a smaller battlefield, inside each of us. What can we do to protect ourselves from cancer and fight it off if diagnosed with it? Cancer is the uncontrolled replication of cells. This happens all the time in our bodies and the immune system deals with the problem. When cancer takes hold however, we must boost the immune system to help fight. But what are
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some things that lead to cancer? Studies have linked a high fat diet to increased risk of breast and colon cancer. (1) Cutting back on foods that are heavy in saturated fats like red meat and processed foods can help reduce that risk. Increasing foods that are rich in phytochemicals such as fruits and vegetables help keep your immune system strong and eliminate free-radicals. Also, estrogen has been shown to be related to breast and uterine cancer, among others. (2), (3) Estrogen is stored in body fat, so maintaining a healthy weight is valuable. We all know that smoking is bad news leading to both lung and bladder cancers, and that we should avoid this nasty habit. Avoid being in enclosed areas such as cars while someone is
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smoking and definitely avoid smoking around the Source, “Exercise stimulates the production children and pets. of endorphins; neurotransmitters that occur naturally in the brain and make us feel good. Though we have seen a large increase in It brings oxygen to our blood and the more the availability and consumption of organic oxygen in the blood, the less hospitable the products, we are still inundated with “Franken- environment to cancer”. (4) foods.” These are foods that have been genetically modified or altered, which are What if we do find ourselves with a cancer also called GMOs or Genetically Modified diagnosis? Though chemotherapy, radiation Organisms. Right now some of our largest and surgery are offered by Western medicine, crops are GMO; corn and soy being the most there are far less invasive natural alternatives prevalent. Monsanto, a multi-national company that can boost your healing. is leading the way in patenting GM seeds and genetically modifying our foods. They are Increase vitamin C. I mean tons of it. Bowel making billions and we are being subjected to, tolerance is a way to tell when the body is done what I believe to be, the biggest human science accepting it. If you spread the doses throughout experiment in history. Regulations are very the day, it’s more easily tolerated and absorbed. lax in this country regarding these practices Too much causes diarrhea, so you don’t want and the food is not only assumed to be safe to get to that point. If it happens, back off the without much testing, but labeling is not a dose. requirement. Beware of foods containing high fructose corn syrup and soybean oil since these It’s believed that cancer cannot live in an not only indicate a highly processed food, but oxygen-rich or alkalized environment. Deep also one that is probably genetically modified. breathing is beneficial as is a hyperbaric chamber if you can find one. A hyperbaric You may be wondering what genetically chamber looks like a tanning bed and delivers modified foods have to do with cancer. Well, oxygen at a pressure higher than atmospheric. unfortunately the jury is still out on that subject. The patient stays in for 30-90 minutes and this Since these foods were not thoroughly tested high pressure oxygen can help cellular health, before release and we don’t know ultimately anti-aging and clearing toxic residue. (5) how these modifications are going to affect Liquid Oxygen is available from health food our own DNA, or combine with each other we stores to drip into water. As far as alkalinity cannot predict what the ramifications will be. I goes, there are supplements available in most advise you to avoid GMOs and let your grocers health food stores, as well as filtration systems and government know you won’t tolerate these that alkalize the drinking water. Also, a diet current food practices. rich in green leafy vegetables and other alkaline foods can contribute to a state of alkalinity. Besides eating organic food and cutting back on saturated fats, what else can we do to stay Studies have shown how important attitude is healthy? How about exercise? Exercise with cancer outcome. A fighting spirit wins. reduces body fat, boosts immune function and This is the biggest competition you will ever gives you a good outlook on life. According to be in and fighting and staying positive will Sara Rosenthal, author of Stopping Cancer at work wonders. Surround yourself with people
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who love you and tell them to remain positive when around you. Prayer is very powerful and people in a group thinking the same healing thoughts can be very beneficial. Eliminating anything processed is recommended. Chemicals and preservatives in food just give your body something else to fight. Whole foods, fruits and vegetables are key. I personally recommend avoiding wheat and dairy as they can be hard on the digestive system. Keeping up nutrition is very important and a good multivitamin, mineral and amino acid formula would be valuable. Some experts recommend a macrobiotic diet, or at the very least going organic and vegetarian. If you can handle the restrictions, these dietary changes can be beneficial, but make sure you get enough protein and amino acids.
no specific link is found between deodorant and cancer, I would avoid this, especially if you have already had a breast cancer diagnosis. (6) Also avoid creams, lotions, cosmetics and sunscreens that contain non-organic products. I HIGHLY recommend testing for both heavy metals and environmental toxin exposure, depending on where you grew up, where you live now and any potential exposure pertinent to your occupation. Both tests are simple; the presence of metal contaminants in the body can be determined by testing a hair sample and environmental toxins can be determined by a simple blood test. You can consult a natural medicine doctor or naturopath to order those tests. If the results come back positive, it would be beneficial to do a cleanse or chelation therapy to flush the chemicals out.
It’s not only important to be selective about There have been numerous doctors persecuted what we are putting IN our bodies, but also and forced out of the United States for their ON our bodies. One of the most commonly work on curing cancer. One is Dr. Hoxsey whose clinic is still functioning in Mexico and the other is a nurse named Rene Caisse. (7) She created a formula called Essiac, which is still available at www.essiac-canada.com. I had a client that used this formula on her husband with melanoma and his recovery was much quicker than expected.
used products is deodorant containing aluminum. We are smearing this daily on some of the most absorbent tissue in the body. Though
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Cancer and health are also affected by personal attitude and mental outlook. As I have mentioned before, I see a large correlation between what we think and what happens in our bodies. I believe one of the reasons we get sick is to let us know something is out of balance with our emotional/spiritual side. Our emotions need to let us know that something must change. When we ignore the emotions we open up the window for sickness. I also believe that malfunctions in our body are the body’s way to communicate that something is
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wrong in our mind and spirit. I believe that if we don’t acknowledge our emotional needs and issues, this energy has to go somewhere and manifests as illness or dis-ease. A child will only scream mommy, mommy, mommy, mommy for so long before he starts pulling things off shelves. This is also what our emotions do. The carpal tunnel, sciatica, neck pain, headaches, psoriasis and cancer is our emotional child pulling things off shelves because it has been ignored. I’m not saying that illness is 100% emotionally formed. There are toxins, poisons and hereditary components to consider. But if our emotions are even responsible for 10% of our illnesses and we can control them, why wouldn’t we?
Visualization for Healing Cancer
Get into a relaxed place, in a comfortable position. Breathe deeply and try to quiet the mind. Get a picture in your head of what you think the cancer looks like. It can be a ball, a blob, whatever it is to you. Picture it in the area of the body where it is growing. As you inhale, send the breath to that organ and tumor and picture it shooting at it, eating it, dissolving it, whatever scene works for you. I always saw it as the cavalry coming over the hill in the old movies to save the day. That cavalry are your white blood cells and they are surrounding the tumor to get rid of it. Hold the picture of the tumor disappearing for as long as you can. Do this visualization as many times during the day If you have already started chemotherapy or as possible. I have seen amazing results with radiation treatments, greet it as a positive thing. this type of meditation. As it’s going into your body, picture it fighting the cancer and see the tumors shrinking. If you fight against the chemo and dread it, or see it as a poisonous enemy, it will not work as well for you. Dr. Kathy Gruver, PhD is a health And last but not least, I encourage you to practitioner, author, speaker and communicate with your health providers. Ask educator. Her first book, The Alternative questions, do your own research and get a Medicine Cabinet is available at her second, third and fourth opinion if necessary. website along with free health tips, a And, if it is in your nature, seek out more monthly newsletter and resources. www. natural cures such those we have covered thealternativemedicinecabinet.com above. We need to be our own advocate. Good luck and good health.
Bio
Resources 1. A diet high in fat significantly increases a woman’s risk of developing invasive breast cancer, according to a study conducted by researchers at the National Cancer Institute in Bethesda, Maryland, and published in the Journal of the National Cancer Institute. 2. http://www.breastcancer.org/treatment/hormonal/what_is_it/hormone_role.jsp 3. http://www.cumc.columbia.edu/news/in-vivo/Vol2_Iss10_may26_03/index.html 4. Rosenthal, M.S. (2001). Stopping Cancer at the Source. Canada: Trafford Publishing. Pg. 72-73. 5. http://www.hyperbaricchambertreatment.com/ 6. http://www.cancer.gov/cancertopics/factsheet/Risk/AP-Deo 7. http://essiacinfo.org
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EMPLOYER SPONSORED CANCER SCREENING
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by Jonathan Spero
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ith healthcare reform mandating coverage for many preventative services employers are taking a closer look at worksite health screenings. Health screenings not only assist in accessing the health risk of population or individual employee, but also pick up undiagnosed diseases that can be very costly if untreated. Employer sponsored metabolic screenings are growing in popularity and identify undiagnosed conditions such as high blood pressure, elevated cholesterol, and diabetes. So what about cancer screenings? Cancer screening exams and tests can pick up life threatening cancers early in the disease increasing the likelihood of a cure. Before employers implement cancer screening programs at the workplace, they need to
understand what the research shows and be guided by evidence based medicine. Evidence based medicine aims to apply the best available evidence gained from scientific method to clinical decision-making. And when it comes to cancer screening, evidence medicine is even more important as the stakes are high and there exists much emotional bias. So what is the evidence for or against cancer screenings? And what are the nationally recognized guidelines? Over 11 million people in the United States have some form of cancer and there are more than 200 different types of cancer. The following are the 10 most commonly diagnosed cancer types in 2009 and the estimated number of new cancer patients diagnosed each year:
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1. Non-melanoma Skin Cancer- 1 million plus (rarely deadly) 2. Lung Cancer – 220,000 3. Breast Cancer – 200,000 4. Prostate Cancer – 195,000 5. Colorectal Cancer – 150,000 6. Bladder Cancer - 70,000 7. Melanoma - 69,000 8. Non-Hodgkin Lymphoma - 66,000 9. Kidney Cancer - 50,000 10. Leukemia – 45,000
Colorectal Cancer Colorectal cancer screening, in general, begins at age 50. Patients have a number of options as follows: • Colonoscopy (every 10 years) OR • Flexible sigmoidoscopy (every 5 years) OR • CT scan (every 5 years) PLUS yearly sampling of stool.
Cervical Cancer
Despite cancer’s enormous prevalence in our population, there exists only a handful of cancer screening tests and exams that have been proven to decrease the mortality related to a specific cancer. These screening tests must be done on a regular interval basis to be effective and include screenings for breast cancer, colorectal cancer, and cervical cancer.
• Regular female exam and pap smear as recommended by your physician
Breast Cancer
Is There any Test for Ovarian Cancer?
Prostate Cancer
The FDA has approved the use of the PSA test along with a digital rectal exam (DRE) to help detect prostate cancer in men 50 years of age or older; together, these tests can help doctors Cancer Screenings Recommendations detect prostate cancer in men who have no symptoms of the disease. In fact, most doctors Below are the current nationally recognized do recommend these tests for their male patients. cancer screening recommendations. The timing However, as previously stated, the research has and frequency of the testing can be modified not yet proven that it will decrease the death based on family history and genetic testing. rate related to this disease in a population.
• Yearly mammograms are recommended Some employers have started ordering the cancer starting at age 40 and continuing for as long a antigen 125 (CA 125) blood test for their health woman is in good health screenings. This test is NOT recommended for • Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over
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Summary Over the next decade several major advances in cancer screening hold enormous promise. However, at this time, effective cancer screening is limited to only a few cancers. Incorporating non-evidence based cancer screening tests into an employer sponsored health screening can actually do more harm than good. False positives can lead to unnecessary follow up procedures, costs, and employee concerns. Employers who are considering health screenings should keep this in mind and stick to nationally recognized cancer-screening guidelines.
Bio women with an average risk of ovarian cancer. Why? While women with ovarian cancer often have an elevated level of CA 125, an elevated CA 125 level doesn’t always mean you have ovarian cancer. Some women with ovarian cancer never have an elevated CA 125 level. And there exist many other conditions (other than ovarian cancer) that can cause an elevated CA 125 level. For these reasons, doctors don’t recommend CA 125 testing in women with an average risk of ovarian cancer. Women with a high risk of ovarian cancer, such as those with mutations in the BRCA1 and BRCA2 genes, which increase the risk of breast and ovarian cancers, may consider periodic CA 125 testing. But even in these high-risk situations, there’s some disagreement about the usefulness of the CA 125 test.
Jonathan Spero, MD, is
CEO of InHouse Physicians and board certified in Internal Medicine. Dr. Spero is an expert in the field of targeted employee wellness programs with measureable ROIs. InHouse Physicians is a global employee health and wellness provider delivering innovative cost containment solutions to corporations around the world. InHouse Physicians high touch employee health services include a wide range of offerings such as cost effective worksite health centers, evidence based “pre-disease” wellness initiatives, health screenings plus analytics, flu vaccinations, and travel medicine. To learn more about InHouse Physicians visit their website at www. inhousephysicians.com or Dr. Spero can be reached at jspero@ihphysicians.com.
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ACCOUNTS CASE STUDY Prepared by: Evolution Benefits & TThe Learning Group
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n 2007 the U.S. Department of Labor funded an initiative designed to further Lifelong Learning Accounts (LLAs), which are employer-matched, portable educational accounts that can help workers finance their education and training. The Learning Group, a Kansas City-based organization piloted the program and established the goal that it would become the model for other States across the nation.
specifically, to disburse funds in the same way as Flexible Spending Accounts (FSA) when combined with a restricted-use MasterCard or Visa. The Learning Group had precise requirements for a TPA partner. They had high expectations for the web application. It needed to be interactive; available in real-time to the employer, employee; and able to manage and capture all necessary data to provide reporting services. The web application also needed to be a seamlessly integrated software solution, The Learning Group sought a Third Party linking financial accounting and reporting Administrator (TPA) to provide its services and, processes.
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In addition to the software requirements, a benefits card was critically important to the success of this initiative. As a result, The Learning Group placed a high premium on a TPA partner that could provide a feature-rich card which was secure, could restrict use only to merchants who sold education materials and supplies, and came equipped with patented auto-substantiation technology, preventing participants from having to hold on to paper receipts, then wait weeks or even months to be reimbursed. Overland Park-based Phillips Resource Network best fit the needs of The Learning Group and was awarded the business due to its exclusive focus on FSAs, high quality customer service, and use of the Evolution Benefits’ Prepaid Benny™ Benefits card.
Tackling a First-of-its-Kind Project
were up to challenge, and with development teams working side-by-side with The Learning Group, completed the project seamlessly in less than six months. Since the LLA funds can only be used for education-related activities (tuition, seminars, certifications, books, supplies, etc.) the card technology needed to restrict transactions to certain types of merchants while at the same time allowing participants the flexibility to make purchases online or at retail merchants of their choice. To address this requirement, EB built a customized education network just for the LLA Initiative. Jerry Katlin, President of Phillips Resource Network noted that EB was responsive, going above and beyond on this particular issue, and “highly focused on customer service.”
“EB’s card and technology was flexible enough Using a healthcare benefits card to administer to allow unusual and distinctive uses,” said LLAs is an innovative application today, but Katlin. “Without the use of Evolution Benefits’ especially was in early 2007. Both Phillips card, the project would not have been completed Resource Network and Evolution Benefits (EB) on time.”
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Results Since Implementation The results speak for themselves. The Learning Group’s original goal to enroll 15 organizations into the program was exceeded with 20 different organizations participating in the LLA Initiative. From The Learning Group’s standpoint, the card makes funds easily accessible for participants, employers, and administrators. They, as well as the organizations enrolled in the program, have realized significant time and financial savings as a result of the card. “Many organizations have a full-time employee for administration of tuition assistance programs, and with the card, time can be re-purposed to other organizational needs.” said Suzy Makalous, Director of Innovation at The Learning Group.
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Given that The Learning Group wanted to ramp up the LLA Initiative nationwide, it would not have been an option without the card. “It provides tremendous scalability. The card makes it simple and easy – that is its greatest strength,” said Makalous. Many employer-sponsored education programs require participants to wait before getting reimbursed for tuition, but with the card, funds for the LLAs are available for use as soon as contributions are saved — an especially attractive feature to those employees living on a tight budget. For more information on this case study contact info@evolutionbenefit.com
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