Employers are confronted with new situations that require evolutionary
thinking about new and more effective approaches to health care cost containment.
“Our belief has always been that it is the
role of the health plan to help coordinate
care between the employee, the provider
and the pharmacy,” says Anthony Benevento, vice president of sales and marketing for UPMC Health Plan. “By doing that,
you have the best chance to deliver the
right care at the right time, and in the most
cost-effective manner. Companies are challenged to find health plans that can best do
that.”
Smart Business spoke with Benevento
about corporate strategies that address
health care cost containment.
What cost-containment strategies should
employers investigate?
Organizations should invest in their
employees by promoting health and wellness. It will not only affect how much you
pay for health insurance, but it will impact
your whole business. Studies have shown
that employees who are overweight and
smoke are twice as likely to miss work for
health-related reasons, are more susceptible to being hurt on the job and are more
likely to have low presenteeism. In addition, these employees are more susceptible
to developing chronic conditions that will
mean higher health care costs.
By creating a work environment that
helps employees modify their behaviors, it
not only benefits the employer, but it helps
the employees throughout their life.
What tactics can engage employees and
lower costs at the same time?
This requires a comprehensive strategy
that combines financial incentives and provides the employee with tools, information
and incentives to take an active role in changing lifestyle behaviors. Employers
often make changes to benefit levels by
shifting more costs to the employees.
However, by doing so they are not addressing the underlying cost drivers.
What tactics work best for large companies
and which work best for small companies?
Regardless of the organization’s size,
senior management must take an active
lead role in promoting a culture of
improved health and productivity. When
this is driven at the highest levels of the
organization, the success rate is dramatically improved.
The size of the organization usually dictates the resources available for a health
and wellness strategy. However, regardless of size, an organization must choose a
health plan partner that possesses the
expertise and methods that have proven
to be successful.
What should employers look for in a tiered
pharmacy program?
Employers should look for a pharmacy program that is structured to obtain the
lowest net cost while achieving the highest
quality of options. This includes the use of
generics and mail order, and using proper
therapeutic substitutes that produce the
same results clinically and the best results
financially.
Would hiring pharmacists to educate patients
about how to reduce drug bills and avoid
dangerous drug interactions help contain
costs?
An employer should partner with a health
plan that possesses this expertise. The
pharmacy arena is very complex and
requires constant strategic modifications
to ensure the best possible results. In addition, it is critical for care management programs to be in concert with the pharmacy
programs.
Would implementing disease management
in high-risk pools be helpful?
Absolutely. Comprehensive disease management programs have a significant
impact on people with high-risk conditions. Since many people have more than
one chronic condition, it is important to
work with a health plan that takes a holistic approach. Rather than focus on a specific disease, focus on the member and all
of his or her physical — and, in some cases,
mental — conditions.
In addition, it is just as important to focus
on people who have the potential to be
high-risk in the future. Care management
programs often make the mistake of only
focusing on members that are considered
high-risk today.
ANTHONY BENEVENTO is vice president of sales and marketing for UPMC Health Plan. Reach him at [email protected]
or (412) 454-7826.