3 tips to boost your healthcare literacy with technology
Historically, the relationship between consumers and their health plan providers has been a distant and somewhat bumpy one. Some health plan providers get a bad rap for poor communications, leaving consumers on their own to navigate a health care system wrought with confusing language, red tape, and unpredictable costs.
The events of a global pandemic have compounded the complexity of dealing with the healthcare system. A recent J.D. Power Survey found that more than 60% of privately insured U.S. health plan members did not receive any guidance about COVID-19 from their providers. The lack of healthcare literacy — knowing what questions to ask and where to get care — has also created a bigger gap between everyday people and their providers. But the good news is technology can help us get more out of our benefits, making our relationship with health plan providers more connected.
The COVID-19 pandemic has exposed the need for more TLC and attention when it comes to benefits. But technology can help us get the most out of our benefits — strengthening our consumer relationship with health plan providers. By engaging with technology, we can improve our healthcare literacy, identify cost-saving opportunities and be more prepared for the unexpected.
If consumers are going to make an informed decision during open enrollment, they’ll need information about the number of visits they paid to the doctor and the costs of their claims to determine if they should change plans. Maybe they’re paying a lot more in premiums, or perhaps they didn’t meet their deductible. Being engaged with your benefits is key to getting the most out of them.
Tip: Avoid going on autopilot with your benefits. Benefits offerings are always changing, and health providers often offer programs that you can opt-in to free. Make sure you’re set up to receive notifications from your benefits administrators and health plan providers. Then take action. Use the preventative care offerings, likes annual wellness check-ups, and enroll in the programs that will serve you now and in the future.
During the pandemic, there has also been an increase in the use of AI to improve communication across the healthcare ecosystem. For example, patient care in the emergency room (ER) is traditionally delivered numerically — first come, first serve. However, AI can help doctors and caregivers at hospitals prioritize the needs of waiting patients. This can lead to a decrease in wait times in crowded hospitals — especially important during the pandemic. In the same vein, AI can help an individual decide if they truly need to visit the ER or if a telehealth option would be more effective and affordable.
Caregiver support platforms, like Cariloop, are using cloud-base technology to improve communication between providers, consumers and their families. This employer-sponsored benefit offers tailored caregiving plans and coaching for families looking for pediatric and senior care. Cariloop, and other caregiver support platforms, use technology to tap into a system of trusted providers and build caregiving scenarios with planning and calculator tools. Users can adjust for different scenarios, review whatresources are available, and receive personal coaching throughout the caregiving journey.
Tip: Viewing benefits as an item to check off a list once a year means you might be overpaying or leaving benefits on the table. Using claims integrations and decision support tools, like planning calculators, can help you and your family fully engage with your benefits and improve your healthcare literacy.
Benefits administrators and health plan providers are beginning to see the importance of supporting the whole person — through mental wellbeing initiatives or by offering online tutoring discounts, streaming virtual fitness programs, and food delivery services.
Tip: Look to the different options that providers use to deliver holistic and preventative care options. For example, year-long access to audio-guided meditation apps like Headspace or programs built around the use of wearable technology that rewards users who meet personalized activity goals. These initiatives go beyond regular patient care and give you tools to support your wellbeing — not just when you’re feeling under the weather.
Tackle growing healthcare costs with earned wage access
As open enrollment begins to trickle in, advisors are looking for new and improved ways to help employees to leverage out of pocket costs on the year that is upon them. For both and employers and employees, healthcare strategies are an integral part of workforce management. Read this blog post to learn more.
It’s that time of year when we all learn that health care costs are going up (again).
As the nonprofit Business Group on Health reported, the average employee will be hit with $15,500 in out-of-pocket costs next year, and the average employer will pick up about two-thirds of that tab. Even with shared responsibility, those are big hits for both employer and worker, which is why health care strategy must be integral part of workforce management.
However, benefits managers may not be aware of a tool that may help keep health care costs down for both employers and workers, and which lets employees more fully participate in the economy they helped create.
Earned Wage Access (EWA), sometimes known as on-demand pay, is a revolutionary benefit that I wrote about back in May. It comes at no cost to employers, and is available to workers at little or even no cost, depending on the provider.
Earned Wage Access allows workers to access a portion of their earned wages that they have not yet been paid on. Depending on the provider, those wages can be immediately accessed on the provider’s payroll card, or just about any debit card.
What does on-demand pay have to do with health care?
When employees receive medical services, payment is often required up front. If employees only get their paycheck every two weeks, they may not have access to liquidity to pay for those services. The result is that an employee may be forced to delay a necessary visit or procedure, and if they are suffering from an acute condition, their health may be severely compromised.
However, with immediate access to the money employees have earned, but not yet been paid on, they have access to health care in the moment. Waiting rooms are bad enough. Waiting periods for basic health care are unnecessary and harmful.
There’s another reason why on-demand pay is critical to your health care strategy. There is a stealth health care crisis brewing in America. Millions have delayed preventative and necessary care due to the COVID-19 situation.
Every delayed preventative screening, test or check-up can result in a failure to discover a serious medical condition that requires treatment. That raises treatment costs down the line for both company health plan and employee.
By wrapping earned wage access into your health care strategy, you can encourage workers to utilize preventative and maintenance care at any time — not just on payday. Doing so also eliminates a common impediment: some people just don’t like to go to the doctor. If they have the excuse not to go, they’ll use it. EWA removes that psychological obstacle.
The same goes for access to medications. High cholesterol, high blood pressure, anxiety/depression, and many other chronic conditions require regular doses of prescribed drugs. Missing even a single day of some of these medications can significantly increase risk of adverse consequences in patients.
Earned wage access allows employees to refill medications when they need to. Waiting can be deadly. Some EWA providers even offer prescription discounts with their smartphone app.
Physicians encourage timely health care for obvious reasons. Employers should encourage it as well, not only out of concern for workers, but because timely health care can result in lower health care costs. However, it’s one thing to encourage timely health care visits. It’s another to offer timely pay to workers so they can meet that request. Earned wage access creates immediate health care access.
On-demand pay usually comes at no cost to employers. Some providers are already integrated with the largest payroll services, and others are integrated with dozens of them. The cost of earned wage access varies by provider, but certain ones offer the service at no cost for employees who use the provider’s payroll card. Other services have costs that are extremely low.
Adding earned wage access to your benefit plan will benefit your overall health care strategy, and your employees.
SOURCE: Meyers, L. (05 October 2020) "Views: Tackle growing healthcare costs with earned wage access" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/tackle-growing-healthcare-costs-with-earned-wage-access
Employers look to virtual services to curb rising health costs
Employers are looking for ways to stem the rising costs of healthcare and find ways to better engage employees. According to the National Business Group on Health, 64 percent of employers believe virtual care will play a significant role in healthcare delivery. Read this blog post to learn more about virtual services.
WASHINGTON — With the continued cost of healthcare benefits expected to increase by another 5%, topping $15,000 per employee, employers are looking for ways to stem the increase and better engage employees in holistic well-being.
One of those ways is through virtual care. The number of employers who believe virtual care will play a significant role in how healthcare is delivered in the future continues to grow, up to 64% going into 2020 from 52% in 2019, according to the National Business Group on Health’s annual healthcare strategy survey.
“Virtual care solutions bring healthcare to the consumer rather than the consumer to healthcare,” Brian Marcotte, president and CEO of NBGH said at a press briefing Tuesday. “They continue to gain momentum as employers seek different ways to deliver cost-effective, quality healthcare while improving access and the consumer experience. Of particular note is the growing interest among employers to offer virtual care for mental health as well as musculoskeletal conditions.”
The majority of respondents (51%) will offer more virtual care programs next year, according to the survey. Nearly all employers will offer telehealth for minor, acute services while 82% will offer virtual mental health services — a figure that’s expected to grow to 95% by 2022.
Virtual care for musculoskeletal management shows the greatest potential for growth, the study noted. While 23% of employers will offer musculoskeletal management virtual services next year, another 38% are considering it by 2022. Physical therapy is the best way to address musculoskeletal conditions and help avoid surgery, but it can be inconvenient and costly, said Ellen Kelsay, chief strategy officer at NBGH.
“Where we’ve seen a lot of development in areas of virtual solutions is to provide remote physical therapy treatments,” she said. “Employees can access treatment through their virtual app wherever it’s convenient for them.”
Regardless, employee utilization of virtual services still remains low. For example, while roughly 70% of large companies provide telemedicine coverage, only 3% of employees use it, according to prior NBGH data.
But many resources are out of sight and out of mind, Kelsay said. However, employers are focusing on offering high-touch concierge services to help workers better navigate the healthcare system.
Employers are reaching a point of saturation with the number of solutions that are available, but from the employee’s perspective, they just don’t know where to start, she added. “These concierge and navigator services really help point employees in the direction to the solution at the point in time they need it.”
In addition, the use of predictive analytics and claims data is also an opportunity to help employers get the right programs in front of employees in the moment, Marcotte added.
“Some of these engagement platforms are getting at personal messaging and predictive analytics. It’s not where we want it to be yet, but as that continues to get better, I think you’ll see utilization go up,” he said.
Engaging employees in healthcare — even while traveling
In 2018, Americans took 463.6 million trips for business, leaving employees unsure of what to do when they get sick or injured while away. Read this blog post for how employers can engage employees who are traveling in healthcare.
Business travel is booming. Americans took 463.6 million trips for business last year. But what happens when a business traveler gets sick or injured while away from home and how can employers help their employees in this situation?
It starts with a simple solution: Make sure you’re providing employees with a health insurance plan that includes coverage outside the state or region where the business is located. While the majority of plans provide coverage for illnesses and injuries that meet the insurer’s definition of an emergency, some plans don’t cover care for common serious, but non-emergency health problems like strep throat, migraine headaches, a sprained ankle or back pain. Employers should ensure they offer at least one plan option that includes either an extended physician and hospital network or coverage for out-of-network care.
If employees need to travel out of the country for business, employers may want to consider offering travel medical insurance, which provides coverage during the period of time while the employee is outside the U.S. and medical evacuation if needed. To ensure employees have all the immunizations they need and are aware of any health risks at their destinations, employers can offer access to or reimbursement for pre-trip visits with a travel medicine specialist.
Even when employees have health insurance that gives them access to care while they’re away from home, connecting with experienced healthcare providers can still be difficult. Some insurers offer phone support for plan members seeking care providers, although often these providers are not heavily vetted for the experience or providing the highest quality care. Health advisory services can also help employees find and connect with healthcare providers in the U.S. and overseas.
When considering health advisory firms, employers should ask how the firm vets the healthcare providers it connects employees with and whether the firm uses a set network of providers or whether it connects employees with the most appropriate providers regardless of their health system affiliation.
Make sure employees know how to find the right type of care
When an employee falls ill or gets injured while traveling for business, her or his first instinct may be to seek care at a local emergency room, but that’s not always the best option. In addition to long wait times, the cost of care delivered in the emergency room is significantly higher than other care settings.
- Employers can help employees make better choices by providing information about the options available and how to choose the right care setting:
- The emergency room for serious, life-threatening illnesses and injuries such as chest pain, symptoms of a stroke, serious burns, head injury or loss of consciousness, eye injuries, severe allergic reactions, broken bones and heavy bleeding
- An urgent care center for conditions you’d usually make a doctor’s appointment for such as vomiting or diarrhea, fever, sprains, moderate flu symptoms, small cuts, wheezing and dehydration
- A walk-in or retail clinic for minor problems such as a rash with no fever, mild flu-like symptoms, sore throat, cough and congestion, ear pain and eye itchiness or redness
- Telemedicine or virtual physician visits for minor illnesses and injuries and advice on whether additional care is needed
The key to helping employees know which care setting is the most appropriate is ongoing communication and education, which can take the form of in-person meetings with the benefits team, newsletter articles and email blasts, and video content shared through the company’s intranet channels.
Employees who are living with chronic health conditions should take special steps when traveling for business, including ensuring they have enough of any prescription medication they take and bringing an extra prescription with them for essential medications in case they’re lost in transit.
Ensure employees can quickly share their medical records with providers
Another important part of the healthcare equation for business travelers is ensuring that when they need care while they’re on the road, the healthcare providers who treat them can get quick, secure access to their medical records. Access to these records is important for several reasons:
- It gives a provider who’s not familiar with the employee’s medical history a comprehensive look at past and current health problems and chronic conditions, medications, allergies or adverse reactions, and treatments and surgeries. Having this information can lower the risk of misdiagnosis, inappropriate care and duplicate care or testing, which not only adds unneeded costs but can also cause harm.
- This information can be especially important when employees are seriously ill or injured and can’t speak for themselves to share medical history and their wishes about issues like the use of a ventilator or feeding tube.
There are several online services and apps that allow users to upload medical records so they can share them with healthcare providers. Another option is to work with a health adviser who can make sure employees’ records are carefully reviewed to ensure accuracy and stored in a secure universal medical record that can be accessed in minutes by treating physicians anywhere in the world.
Giving employees who travel for business the right resources and guidance can not only increase their peace of mind, it can help make sure they have access to the care they need wherever work takes them.
SOURCE: Varn, M. (18 June 2019) "Engaging employees in healthcare — even while traveling" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/engage-employees-in-healthcare-when-traveling
Taking the first steps to a long-term benefits strategy
A common struggle for many companies that are searching for a cost-effective, successful employee benefits strategy is that HR professionals and finance professionals have conflicting objectives. Continue reading this blog post to learn more.
The quest for a cost-effective and successful employee benefits program can feel like a search for the Holy Grail. To most, it’s an elusive goal within the context of rising and unsustainable costs.
Unlike “Monty Python and the Holy Grail,” in which a comedy of errors made for a hilarious movie, nonsensical benefits strategies can have serious consequences.
One major challenge is that many HR and finance professionals have conflicting objectives. HR’s mission is to design a program that is competitive in the marketplace for human capital needs while supporting the organization’s culture. Finance, on the other hand, is charged with managing to a budget by controlling expenses to mitigate year-over-year increases. The result, in spite of best intentions, leaves organizations unable to commit to a multi-year plan and opt in favor of living year-to-year.
So, how do you overcome this challenge?
Step 1: Key HR and finance stakeholders need to align on goals and objectives. They also need to remain engaged in the process throughout the year (not just at renewal). Once you achieve alignment, these objectives should be memorialized into a benefits philosophy. Why? So the collective team has guiding principles for future decisions.
Step 2: Identify the cost drivers of the program. Many employers have little line of sight into how their plan is performing until it’s too late. Once you are staring down the barrel of a 25% increase, an organization may be forced to make swift changes to soften the blow to their bottom line rather than follow a strategic approach that comes with preparation. Unfortunately, this type of knee-jerk reaction only temporarily relieves the pressure and may create unintended consequences to the employee value proposition.
Step 3: Understand where you were, where you are and where you want to be. After 25 years in the consulting industry, one thing I know for certain is there are only so many levers you can pull to rein in escalating benefit costs. Identify the levers and how far you want to pull them.
Step 4: Determine success metrics. I’ve seen many organizations implement new tactics, such as a health savings account. When I ask them if it was successful, they can’t answer because they didn’t set an internal bar for success. That barometer will help you gauge success and determine what changes need to be made to your approach to achieve your goal.
Step 5: Commit the plan to writing and review it periodically. Just like your company’s overall business plan, you will need to make adjustments along the way as your business changes.
Regardless of strategy, I recommend employers take steps toward a self-funding benefits model. Historically, self-funding was for groups with 1,000 lives and above. But that’s no longer the case. Self-funding provides that all-important line of sight into cost drivers because of access to claims data. Having a deeper understanding of the “why” behind costs allows an organization to implement a data-driven approach to the overarching benefits strategy. Self-funding also provides more plan design flexibility and eliminates the internal costs that an insurance carrier builds into a plan for profit.
It’s more effective to create a benefits strategy that is sustainable over time, so when you inevitably endure a higher-than-normal renewal cycle, typically every three to five years, you are prepared to stay the course.
Consider timing. When you make changes to a benefit plan is just as important as what changes you make. Evaluate the timing of benefit changes, how they are implemented and how adjustments will impact your workforce now and in the future.
For example, if you plan to add new voluntary benefits, such as indemnity plans, it may make sense to run them “off cycle” from the core medical benefits open enrollment season. This gives employees more time to conduct research about the new product option and make an educated decision.
Strive for simplicity. I can’t stress this enough. The Affordable Care Act, an increase in voluntary benefit options, new funding models and benefit trends have created an enormous amount of noise in the insurance industry. Tune it out and simplify your process as much as you can. Your HR and Finance teams are overwhelmed and so are your employees. Instead of throwing new benefits at them each year, focus on educating them and making choices simple. In fact, any long-term benefits plan worth its weight always includes an education and communications component.
Benefit illiteracy is rampant, and confusion over options at open enrollment can have consequences for the employee throughout the plan year. If your employees choose their benefits online, spend the open enrollment meeting educating them on how to buy and consume insurance, rather than just what the benefit choices are for the plan year, or how to use the online enrollment tool. You should also communicate throughout the year, rather than just at open enrollment to support employees’ understanding of their benefits program.
Identify other areas where employees might struggle. One trend is to offer transparency tools to help them choose a doctor or specialist. But be aware that the sheer number of doctors in a given list can be overwhelming. Rather than offering employees a choice of 50 doctors, narrow it down to five providers with the best healthcare outcomes.
Making it simpler for employees to be better consumers of healthcare will help you cut costs and get on the right path to a long-term benefit strategy. Of course, you’ll have to check in each year and consider making small adjustments to the program, and data will help guide these changes. Adjustments should all be in service of a long-term plan. If you begin your long-term plan by asking the question, “Where were we, where are we now and where do we want to be in the future?” you’re halfway there. You may eventually find that your Holy Grail is within reach.
SOURCE: Bloom, A. (14 May 2019) "Taking the first steps to a long-term benefits strategy" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/taking-the-first-steps-to-a-long-term-benefits-strategy
Getting employees up to speed with health literacy
Do your employees know how much sugar is in a granola bar or how much radiation is in a CT scan? If not, it's most likely because no one is teaching them. Continue reading to learn more on getting your employees up to speed with health literacy.
Your employees probably don’t know how much sugar is in a granola bar or how much radiation is in a CT scan. They may not even know how to reach your employee assistance program.
That’s because no one is teaching them. Which is what happens when wellness program education ends at eat more fruits and vegetables and avoid added sugar.
Sometimes the advice is even wrong. For example, below is a clipping from a popular health risk assessment. Focus on the lower right quadrant.
It isn’t entirely true that low-fat and nonfat dairy is healthier. In fact, full fat dairy does have health benefits, for example some studies suggest it could help protect against diabetes. By comparison, low-fat or nonfat yogurt could be a significant source of sugar.
This is why employee health literacy is so important. With easy access to mis-information, employees need to learn to sift through the noise to determine what is actually good for them.
Plus, there is plenty to learn. Spanning from everyday health, employee medical education and health benefits literacy. I’ve outlined just a few of the ways to employers can better educate their population.
Everyday health education
Sugar is one place where health education could be more impactful — but it should go beyond just telling workers to avoid added sugars. Education starts at work. Chances are your break room is stocked with granola bars, maybe Clif Bars. The first ingredient in a Clif Bar is organic brown rice syrup. That may sound healthy, but it’s really just sugar. In fact, there are almost 60 different sugars disguised with fancy names like turbinado or malted barley extract.
Another example is sleep. We all want employees to get enough of it, but do they know how? They may not know little bits of information that could help them get more shuteye, like there is a night shift setting on their iPhone or that energy-efficient light bulbs contribute to insomnia.
But teaching everyday health is just the beginning of health literacy. The real impact comes with employee medical education.
Employee medical education
U.S. consumers are voracious purchasers of healthcare services and yet our outcomes remain poor. Americans have about 240 CT scans per 1,000 people. To put that in perspective, only about 1 in 1,000 covered people in your employee population was hospitalized for diabetes last year. So 240 times more employees are getting scans than uncontrolled diabetes.
CT scans have risks. They have about 500 times the radiation of an x-ray and are especially concerning for children because their cells are dividing more rapidly than adults and are more sensitive to radiation exposure. The dye used intravenously also carries a risk.
But many employees don’t know about these risks. So it may be important to educate your workforce about these common medical procedures and how to decide whether or not it is right for them.
Health benefit education
Here’s a wild guess: your employees don’t appreciate the health benefits you provide for them. If so, you’ve got company. Most large organizations face the same issue.
Consider the employee assistance program. Do workers know you offer one? Do they know it’s confidential? They know their emails aren’t confidential, so don’t assume they know this. Do they know the URL, username and password? How many free sessions do they get?
Repeat a similar set of questions for all your benefits. You can’t expect that some memos and a website will implant your benefits firmly in their mind.
SOURCE: Lewis, A. (25 April 2019) "Getting employees up to speed with health literacy" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/educating-employees-through-health-literacy
Think your employee is faking sickness? Here’s what you can do
Have your employees misused their FMLA leave before? Navigating FMLA can be tricky, leading to costly lawsuits if a wrong move is taken. Continue reading this blog post to learn more about handling FMLA misuse.
Your employee’s gout flared up, so they took the day off using intermittent medical leave. Later on, a photo of the same employee sliding into home base surfaces on social media that day. How do you find out if the employee was misusing FMLA leave?
Bryon Bass, senior vice president of workforce absence at Sedgwick — a business solution tech company — says navigating FMLA can be tricky, and the wrong move can provoke costly lawsuits. But if an employer has reason to believe the absence isn’t valid, Bass says there’s a process they can follow to investigate.
“I think [a social media photo] casts doubt on the reason for their absence,” Bass said during a recent webinar hosted by the Disability Management Employer Coalition. “It merits a second look, along with some potential code of conduct talks with HR.”
When a questionable situation arises, employers can ask for the worker’s approved medical condition to be recertified, Bass said. This involves having the employee resubmit their original FMLA application. Afterward, employers can send a list of absences to the employee’s healthcare provider to authenticate the dates as valid medical absences. Typically, employers can only request recertification after a 30 day period, unless there’s reason to believe the employee is taking advantage of the system.
“If, for example, you notice two employees — who happen to be dating — are taking off the same days for their different medical conditions, that’s a valid reason for asking for recertification,” Bass said. “Patterns of absence are a common reason to look into it.”
Instead of requesting recertification, some employers make the mistake of contacting the employee’s physician directly — a process called clarification. Employers are only allowed to use clarification during the initial FMLA application, and only after obtaining the employee’s permission. Clarification is used to answer employer questions about the amount of rest an employee’s condition merits.
Employers might not trust the opinion of their employee’s doctor, but they can’t ask for a second opinion until it’s time for the employee to re-submit their annual certification, Bass says. When that time comes, employers can appoint a physician to reexamine the employee at the company’s expense. If the employee objects to the second doctor’s report, a third opinion can be sought.
“With third opinions, both the employer and the employee have to agree on the provider because their decision is final,” Bass said. “Employers are also required to cover this expense.”
Although employers are within their right to file recertification, Bass says it should be done sparingly and in situations where evidence suggests misuse. An employee using slightly more time for recovery isn’t automatically abusing the policy, he said.
“FMLA does not permit healthcare providers to provide an exact schedule of leave, just an estimate of absences necessary for the employee’s treatment and recovery,” Bass said. “Treatments are more predictable, but it’s still only an estimate. If someone takes a little more time than estimated, it doesn’t mean you need to ask for recertification; in fact, the Department of Labor discourages that.”
SOURCE: Webster, K. (24 April 2019) "Think your employee is faking sickness? Here’s what you can do" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/how-to-certify-medical-leave-and-handle-pto-requests?feed=00000152-a2fb-d118-ab57-b3ff6e310000
Digital health revolution: What we’ve learned so far
Digital health devices provide personalized feedback to users, helping improve their health. Continue reading this blog post to learn more about the evolving digital health revolution.
The promise of the digital health revolution is tantalizing: a multitude of connected devices providing personalized feedback to help people improve their health. Yet, some recent studies have called into question the effectiveness of these resources.
While still evolving, many compelling use-cases are starting to emerge for digital health, including a set of best practices that can help guide the maturation of this emerging field. In the near future, many people may gain access to individual health records, a modern medical record that curates information from multiple sources, including electronic health records, pharmacies and medical claims, to help support physicians in care delivery through data sharing and evidence-based guidelines.
As these advances become a reality, here are several digital health strategies employers, employees and healthcare innovators should consider.
Micro-behavior change.
Part of the power of digital health is the ability to provide people with actionable information about their health status and behavior patterns. As part of that, some of the most successful digital health programs are demonstrating an ability to encourage daily “micro-behavior change” that, over time, may contribute to improved health outcomes and lower costs. For instance, wearable device walking programs can remind people to move consistently throughout the day, while offering objective metrics showcasing actual activity patterns and, ideally, reinforcing positive habits to support sustained change. Technology that encourages seemingly small healthy habits — each day — can eventually translate to meaningful improvements.
Clinical interventions.
Big data is a buzz word often associated with digital health, but the use of analytics and technology is only meaningful as part of a holistic approach to care. Through programs that incorporate clinical intervention and support by care providers, the true value of digital health can be unlocked to help make meaningful differences in people’s well-being. For instance, new programs are featuring connected asthma inhalers that use wirelessly enabled sensors to track adherence rates, including frequency and dosage, and relay that information to healthcare professionals. Armed with this tangible data, care providers can counsel patients more effectively on following recommended treatments. Rather than simply giving consumers the latest technologies and sending them along, these innovations can be most effective when integrated with a holistic care plan.
Real-time information.
One key advantage of digital resources, such as apps or websites, is the ability to provide real-time information, both to consumers and healthcare professionals. This can help improve how physicians treat people, enabling for more customized recommendations based on personal health histories and a patient’s specific health plan. For instance, new apps are enabling physicians to know which medications are covered by a person’s health plan and recommend lower-cost alternatives (if available) before the patient actually leaves the office. The ability to access real-time information — and act on it — can be crucial in the effort to use technology to empower healthcare providers and patients.
Financial incentives.
Nearly everyone wants to be healthy, but sometimes people need a nudge to take that first step toward wellness. To help drive that engagement, the use of financial incentives is becoming more widespread by employers and health plans, with targeted and structured rewards proving most effective. From using mobile apps and comparison shopping for healthcare services to encouraging expectant women to use a website to follow recommended prenatal and post-partum appointments, financial incentives can range from nominal amounts (such as gift cards) to hundreds of dollars per year. Coupling digital health resources with financial rewards can be an important step in getting — and keeping — people engaged.
The digital health market will continue to grow, with some studies estimating that the industry will exceed $379 billion by 2024. To make the most of these resources, healthcare innovators will be well served to take note of these initial concepts.
SOURCE: Madsen, R. (14 March 2019) "Digital health revolution: What we’ve learned so far" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/digital-health-revolution-what-weve-learned-so-far?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001
What HR pros should know about clinical guidelines
Sets of science-based recommendations, also known as clinical guidelines, are designed to optimize patient care in areas such as screening and testing, diagnosis and treatment. Read this blog post for what HR professionals should know about these guidelines.
Your employees and their family members frequently face tough questions about their healthcare: How do I know when it’s time to get a mammogram? When does my child need a vision screening? Should I get a thyroid screening? If I have high blood pressure or diabetes, what is the best treatment for me?
For the providers who care for them, the key question is: How do we implement appropriate, science-backed treatments for our patients, testing where needed, but avoiding potentially harmful or unnecessary (and expensive) care? The answer is to seek guidance from and use clinical guidelines —along with existing clinical skills — wisely.
Clinical guidelines are sets of science-based recommendations, designed to optimize care for patients in areas such as screening and testing, diagnosis and treatment. They are developed after a critical review by experts of current scientific data and additional evidence to help inform clinical decisions across a spectrum of specialties.
Based upon this process, guidelines are then released by a number of sources and collaborations, including academic and non-profit healthcare entities, government organizations and medical specialty organizations.
From preventive care to treatment protocols for chronic conditions, guidelines provide a framework healthcare providers use with patients to help guide care. However, it’s important to note that clinical guidelines are not rigid substitutes for professional judgment, and not all patient care can be encompassed within guidelines.
The impact on healthcare and benefits
Clinical guidelines are used in myriad ways across the healthcare spectrum, and providers are not the only ones who utilize them. Insurers also may use guidelines to develop coverage policies for specific procedures, services and treatment, which can affect the care your covered population receives.
To illustrate a key example of an intended impact of guidelines on health plan coverage, consider those issued by the U.S. Preventive Services Task Force, whose A and B level recommendations comprise the preventive services now covered at no cost under the mandate of the Affordable Care Act.
As another example, the National Committee for Quality Assurance, which accredits health plans and improves the quality of care through its evidence-based measures, uses the American Heart Association guidelines when creating its quality rules for treating high cholesterol with statin drugs.
Other examples exist among commercial coverage policies. For example, some cancer drug reimbursement policies use components from nationally recognized guidelines for cancer care.
Because science is rapidly changing, guidelines are often updated, leading insurers to revisit their policies to decide if they will change how services and medications are covered for their members. Providers and health systems may modify processes of patient care in response to major changes in guidelines and/or resultant changes in payer reimbursement.
Not all guidelines are updated on a set schedule, making it even more important for providers and organizations that rely on guidelines to stay on top of changing information, as it can have a direct impact on how they work. Attending conferences, visiting the recently established ECRI Guidelines Trust, and regularly reviewing relevant professional association websites and journals can help ensure needed guidelines are current. Lack of current information can affect care decisions and potential outcomes for patients. Those who have access to the most up-to-date, evidence-based information are able to work together to make well-informed healthcare decisions.
Why it matters for employers
As employers or benefits consultants, it’s critical to ensure that your health plan, advocacy or decision support providers, and other partners that depend on this information to guide their practices and decisions understand and follow current, relevant guidelines.
Further, by combining information from relevant guidelines and data from biometric screenings, health risk assessments, claims and other sources, it’s possible for clinical advocacy and other decision support providers to identify employees with gaps in care and generate targeted communications (through a member website and/or mobile app) to help them take action to improve their health.
Clinical guidelines are science distilled into practical recommendations meant to be applied to most patients for quality healthcare. By maintaining current, relevant guidelines, organizations and providers who work with your covered population can ensure that all parties have the key information they need to make the best decisions for their health.
SOURCE: Sivalingam, J. (18 March 2019) "What HR pros should know about clinical guidelines" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/what-hr-managers-should-know-about-clinical-guidelines?feed=00000152-a2fb-d118-ab57-b3ff6e310000
To check or not to check: Managing blood sugar in diabetic employees
There's been a growing prevalence of Type 2 diabetes in the U.S. over the last 20 years. This chronic condition significantly impacts employees, their family members and even employers clinically and financially. Read this blog post to learn more.
Over the last 20 years, there’s been a growing prevalence in the U.S. of Type 2 diabetes, a chronic condition that significantly impacts employers, their employees and family members clinically, financially and through quality of life. With that comes an increase in the use of insulin for people with Type 2 diabetes to better control blood sugar to reduce long-term complications, which includes eye, kidney and cardiac disease, as well as neuropathic complications.
Most of these patients manage their condition with oral medicines versus insulin, and it’s estimated that 75% of patients with Type 2 diabetes regularly test their blood sugar, even though doing so may not be needed. Blood sugar testing is an important tool in managing diabetes as it can help a patient be more aware of their disease and potentially control it better. But it also can be painful, inconvenient and costly.
Blood sugar testing can be an important tool in managing diabetes, and there are two types of tests. The first is a test conducted at home by the patient that shows the blood sugar at a specific point in time. The second type is called HA1c (a measure of long-term blood sugar control) that shows the average blood sugar over the last two to three months. The value of at-home testing is now thought to be questionable.
In 2012, the Patient-Centered Outcomes Research Institute began a study to evaluate the value of daily blood sugar testing for people with Type 2 diabetes not taking insulin. The endpoint for the study was whether there was a difference in HA1c levels for those who did daily testing and those that did not. The conclusion of the study found that there were no significant differences between those two populations.
In response to these findings, the institute developed an initiative called Rethink the Strip that involves stakeholders including primary care practices, healthcare providers, patients, health plans, coalitions and employers. Given the cost for test strips and monitors for patients with Type 2 diabetes who test their blood sugar daily, it’s important to adopt an evidence-based patient-centered approach around the need for and frequency of self-monitoring of blood glucose.
As employees and employers cope with the costs associated with blood sugar testing, there are several strategies that should be considered to better manage this issue. They include:
1. Support shared decision-making. Like all interventions within healthcare, it’s important to weigh both the benefits and the risks of daily blood sugar testing in a thoughtful manner between the patient and their provider.
2. Managed benefit design. Employers should pay for daily blood sugar test strips in cases where it brings value (e.g., Type 1 and Type 2 patients who are taking insulin as well as patients that are either newly diagnosed or are going through a transition period, for example, post hospitalization or beginning a new medication regimen).
3. Involve vendors. To ensure alignment in all messaging to plan members, ask health systems and/or health plans and third-party vendors to align their communication, measurement and provider feedback strategies on when it’s appropriate for daily blood sugar testing.
These strategies can help employees with diabetes understand how their daily activities (nutrition, exercise and stress) and medications impact their condition. This benefits the employee in reaching treatment goals and feeling their best, while also helping employers and employees reduce the need for unnecessary and costly test strips.
SOURCE: Berger, J. (14 March 2019) "To check or not to check: Managing blood sugar in diabetic employees" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/managing-blood-sugar-in-diabetic-employees?brief=00000152-146e-d1cc-a5fa-7cff8fee0000