Consumer-driven health plans creating options for workers, employers

By Linda Redeffer

Business Today

Business owners, especially owners of small businesses, should remember when considering employee health care programs that one size does not fit all.

When reviewing a health plan, an important question is trying to make sure that it provides value to the employees. Not every plan is going to fill all needs -- some will need more and others won't use it at all. However, more and more insurance companies are offering consumer-driven health plan which means that employers and insurance providers are offering more options to consumers along with more information about those options.

Employers also need expert help in planning for employee health care benefits, says Randy Ressell, vice president of sales for Anthem Blue Cross and Blue Shield in Missouri.

A professional insurance agent or a consultant knows more about what is available and what is changing in health care, Ressell said.

"They will have a good idea of what an employer is looking for before they start," he said.

It sounds complicated, Ressell said, but only on the surface. Most insurance providers offer policies that feature wellness programs and encourage employees to make lifestyle changes that will improve their health. In the next five to 10 years, Ressell said, the insurance industry will move into a different direction, offering consumers more options and choices in their claims coverage. Some of that change is beginning with this current year, he said, leading toward consumer-driven coverage.

"The financial rewards come from doing the right thing," Ressell said. "The goal is to improve the health of the members."

Studies have shown that three major health concerns drive up the costs of health care -- obesity, tobacco use and a sedentary lifestyle. More than 60 percent of insurance costs incurred in the last decade are due to these major concerns, which lead to high cholesterol, diabetes, coronary artery disease and joint and back pain.

"As customers get engaged in their education, it will improve their health, and help make premium rates more affordable," he said. "The real cost of health care is not administrative costs, but the cost of claims."

Companies that encourage their younger employees to pay attention to their health and fitness are making an investment in those employees as they age and saving money in the long run by making premiums affordable.

Incentives have an impact on behavior, said Deborah Wiethop of Anthem Blue Cross Blue Shield.

Wiethop cited a recent study from an insurance association that shows people eligible for consumer-directed plans were 17 percent more like to participate in an exercise program than those in a non-consumer-directed program. These consumers are also 20 percent more likely to participate in a smoking cessation plan, 22 percent more likely to participate in a stress management program, and 27 percent more likely to participate in nutrition and diet programs.

Educating employees about good health not only will in the long run make premiums more affordable, but it also affects a company's bottom line by making a more healthy, productive work force. It's an investment in the employees and in the success of the business, Wiethop said.

Other incentives for employees include tax breaks brought about by flexible spending plans, products that promote the usage of in-network physicians at lower out-of-pocket cost and generic drugs at a lower cost. Some employees are willing to trade a lower deductible and have higher office copays in exchanged for increased wellness benefits or vision coverage, Wiethop sad.

Health insurance is changing, becoming more consumer-directed, Ressell said.

"It's becoming highly competitive, he said. "We're hoping the competition added to the system will work and keep it affordable. People are starting to take ownership of their health status. If we do a better job we can reduce some of the costs involved."