As new vaccines and preventive medicines hit the market, employers and
insurance companies are often hesitant to include these items in their plans. It
is important for employers to work with
insurance providers and weigh both sides
of the equation to determine if investing in
preventive measures may actually reduce
overall health costs.
“The best thing you can do for high-price
patients is prevent their problem,” says
Bruce Niebylski, M.D., associate vice president of medical affairs with Priority Health.
While it may be difficult to directly measure a return on investment, the data collected by agencies, such as the Centers for
Disease Control and Prevention (CDC) and
the National Institutes of Health (NIH), is
overwhelmingly convincing. Today, employers have options to design their benefits in ways that encourage employees to
choose healthier lifestyles.
Smart Business spoke with Niebylski
about benefit design and how employers
can measure the return on investment for
preventive measures.
How can benefit design encourage healthier
lifestyles?
There are millions of vaccines, medications, treatments and simple lifestyle
changes that individuals can implement to
encourage healthier lifestyles.
When dealing with lifestyle, you are dealing with human behavior. People tend to
do things that are simple, convenient and
that other people are doing. By designing a
plan that caters to such desires, employers
and benefit providers can help reduce
overall health care costs by helping consumers lead healthier lifestyles.
Today, some vaccines, such as the flu
shot, are offered at grocery stores. This
increases the likelihood of consumers utilizing the shot, therefore increasing overall
health. A simple design change can have
positive effects in an employer’s health
benefit plan.
Do benefit plans cover preventive services?
Almost all preventive services are covered. About 10 years ago, screenings such as mammograms and colonoscopies were not
covered by health plans. Benefit providers
have since researched the value of preventive measures and determined a significant
reduction in overall health care costs.
As new products are introduced to the
market, there is still some hesitation as to
whether they should be covered by a
health care plan. Gardasil is a new vaccine
on the market that is to be used to prevent
human papillomavirus (HPV), a leading
cause of cervical cancer. This vaccine
reduces the risk of getting HPV by 75 percent. After research, many health plans
realized it was far cheaper to invest in the
prevention than to pay for the treatment of
a cervical cancer patient.
How can one measure the return on investment (ROI) for preventive health services?
Many different organizations, such as the
CDC and the NIH, realize the importance
of showing the ROI of preventive measures
to consumers. There have been many studies done to show that preventive methods
lead to less absenteeism, therefore leading
to greater productivity. Studies show that
prevention decreases susceptibility to diseases that are in one’s environment. One
company tested the theory of compliance
of care by eliminating all co-pays on medicines that treated such diseases and ailments as diabetes, high blood pressure and
depression. When the company eliminated
the co-pays, it found that its employees followed their medication regimen much
closer and were less likely to miss work for
illness and their overall health care costs
went down. By investing a little more
money upfront, the employer saved money
on health care costs because it had to pay
far less medical costs.
Why are employers turning to preventive
measures instead of treatment?
The evidence shows it is cheaper for an
employer to take simple steps to improve
employee health than it is to treat illness.
Employers can encourage employees to
take short walks on their breaks, or redecorate stairwells to make them more inviting to encourage people to use the stairs.
Vending machines that contain fatty foods
and sodas can be removed and replaced
with healthier food options. These changes
may cost an employer upfront but can save
the employer in overall health care costs.
Encouraging the use and regular visits to
a general physician is beneficial to employers, as well. Too many people use the emergency room as their primary place for
treatment. The ER should be used for
emergencies only.
Is it ever too late to implement a healthier
lifestyle and utilize preventive measures?
It is never too late. The earlier you make
significant changes the better. There is
always room for improvement. You don’t
have to change your life; you just need to
be smart about life.
Often, changes in behavior are tied to a
social situation. It is important to recognize
how you respond to life-changing events,
such as children moving out or a loved-one
passing away, and create healthy habits in
response.
BRUCE NIEBYLSKI, M.D., is associate vice president of medical affairs with Priority Health. Reach him at (248) 324-2763 or
[email protected].