Managing health

As health care costs rise, insurance providers and employers continually look for ways to cut costs.

Human resource professionals, as well as business owners, are feeling the squeeze between trying to provide adequate coverage for employees and staying within a reasonable budget.

Seven out of 10 insured Americans are covered by a managed health care plan. More than 70 percent of employers offer a managed care plan to their employees. According to the American Association of Health Care Plans, as health care costs rise, managed care plans save both employees and employers 10 percent or more per year.

Industry leaders from both employee benefits and the health care industries suggest that part of that savings comes from the educational programs provided by managed care plans, which are key in reducing costs and boosting productivity through fewer sick days and healthier employees.

A Society for Human Resource Management analysis suggests that producing a quarterly benefits newsletter can help control costs. The research points to an ample understanding of a company’s benefits package as a way to help employees make more cost-effective decisions.

Rich Ostuw, a consultant for the global group benefits and health care group Watson Wyatt Co. based in Bethesda, Md., says that many companies aren’t getting the most of their benefits programs. He suggests that “the one-size-fits-all managed care approach simply doesn’t work any longer.”

Ostuw recommends educational programs and disease management programs for employees to help control health care costs and improve employee relations. Disease management programs, also called health management programs, are a proven, cost-effective way to tackle and control certain conditions.

Common health management programs are designed to educate patients who have been diagnosed with particular diseases or conditions. Programs include in-home visits from registered nurses and other clinicians for conditions such as pregnancy, asthma, diabetes and heart disease.

A case manager (also a registered nurse) is generally assigned to the patient to talk with the family about the disease, answer questions and provide education about medications, limitations and side effects.

The American Medical Association reported a recent study concluded that, “In general, educational programs improve knowledge, compliance, self-management behavior, family coping and school attendance or performance.”

For asthma patients, several controlled studies showed that educational programs reduced the use of health care services such as visits to the emergency room and urgent care centers. Asthma patients, in particular, benefit greatly from the personalized guidance provided through health management programs. The home environment, the patient and the disease have many variables contributing to the treatment and management of the disease.

The AMA’s report says, “Self-management education provides the patient (or child and parent) with the technical knowledge and skills to promote changes in behavior that will improve health status and enhance quality of life.”

The Saint-Gobain NorPro Corp., based in Stow, is one example of a company that is taking advantage of health management programs. The company manufactures ceramic and metal products used in the chemical and oil refinery business and employs nearly 200 in Northeast Ohio and more than 300 across the United States.

Gideon Oswitch, employee benefits coordinator for Saint-Gobain NorPro Corp., says benefits such as health management programs can produce a positive results for both the employee and the company.

“With many diseases and conditions, early intervention is so important,” Oswitch says. “If you leave certain conditions untreated, the cost is going to be astronomical.”

Oswitch pointed to his family’s own experience with a health management program for expectant mothers. He and his wife utilized the services when they were expecting a child.

“The days of having house calls from your doctor are extinct,” Oswitch says. “But with this program, you have an expert coming right to your house. And, sometimes, you have questions or problems where you wouldn’t need a full doctor’s appointment. If you have questions about breast feeding or how the crib should be set up, you can ask the nurse.”

Oswitch says the nurse was available to assist with prenatal care and follow-up after the baby was born. The program also offers educational opportunities.

“The nurse brought over a video and literature for us,” Oswitch adds. “They also provided us with a hotline number so we could call on a nurse at anytime. It was very comforting to know that you could call someone or have a nurse come out at any time — I found it very reassuring.” How to reach: Saint-Gobain NorPro Corp., (330) 673-5860