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Acing the ACA

Wellness: The Next Frontier

There’s no “one-size-fits-all” wellness program for all employers. Sure, this week it’s watch your fat intake and don’t smoke, but those aphorisms do not a wellness program make.

June 2, 2014
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Related Topics: Health Care Costs, Health and Wellness, Health Care Benefits, The Latest, Benefits
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Castor oil. Yep, that’ll keep the body well. Or maybe Gripe Water, for British babies with colic, and perhaps the best-named old-fashioned home remedy.

But we know what leads to wellness, at least since the 18th century: An apple a day keeps the doctor away.

Those and many more formed the basis of many companies’ wellness programs for years. I know when I went to my doctor for my annual checkup and asked what I could do to keep young and healthy and was told “diet and exercise,” I asked what else he might have to offer.

Gary B. KushnerBut here’s the thing: There’s no “one-size-fits-all” wellness program for all employers. Sure, this week it’s watch your fat intake (although a study in March 2014 indicated that perhaps some saturated fats might actually be good for you), and don’t smoke, and get a modicum of exercise now and then. But those aphorisms do not a wellness program make.

Neither does buying gym memberships for all of your employees. Those who previously went to the gym will thank you for the nice subsidy of what they would have paid for anyway, and those whose last experience in a gym was PE in high school will just yawn. Your return on investment will be minuscule if anything at all.

No, to be serious today in affecting the ever-increasing health care costs, reducing absenteeism (and its related costs), presenteeism, and the general productivity of the workforce, something much more tailored to each organization’s specific makeup must be considered and subsequently implemented.

This requires a much more data-driven, scientific approach. The first step in building a wellness program is determining what it is your employees and their dependents have been spending the plan’s money on. Second, which of those items are preventable, or could be reduced or eliminated via a specific type of intervention? It is only then that you should begin to build your wellness program. I like to refer to that process as “targeted wellness.” It’s targeted to your own employee population and their dependents, and the type of plan expenses you see occurring over a period of time, typically one year or more.

For example, a smoking cessation program is great, and you can often find a decent ROI on it in a general population. But what if your employee base is all 20-somethings who happen to be Olympic swimmers? Think smoking cessation will have much of a return on investment?

Let’s say you do a deep-dive utilization review, examining your claims data and cross-tabbing it by the demographic characteristics of the claimants, as well as whether the treatment is recurring or nonrecurring, preventable or nonpreventable and benchmarked against the larger general population, again by demographics, region and employer size. Only then can you see how your plan’s expenses compare, and then begin targeting by specific disease or condition type where to focus your organization’s wellness efforts.

As an example, a midsize employer with approximately 1,000 employees had in place a generic wellness program. In reviewing its effectiveness, it asked its wellness vendor for an ROI for the effectiveness of its wellness approach. The vendor was unable to provide any kind of meaningful statistics, and so the employer turned to a targeted wellness approach.

It began by performing an extensive utilization review of the health and prescription drug expenses for the prior three years. Examining the results of that review determined that some of the items that its old wellness program focused on weren’t even an issue for its employees and family members, while its plan expenses for diabetes were more than 225 percent above the norm for a group with its demographics and geographic locations.

It then designed an entire initiative around diabetes education and proactive intervention where either hemoglobin A1C tests or prescription protocols weren’t being followed. As a result, it saw a marked decline in costs related to diabetes treatments in the subsequent plan year.

So with wellness, the bottom lineis the bottom line, in addition to providing a more meaningful benefit to employees and family members. Designing a targeted wellness program positively affects employer and employee health cost, can positively impact absenteeism, presenteeism and productivity, and can improve the health of employees and their families.

Gary B. Kushner is the president and CEO of Kushner & Co., a benefits consulting firm. Comment below or email editors@workforce.com. Follow Workforce on Twitter at @workforcenews.

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