Employers and health insurers are moving quickly away from fee-for-service health care benefits plans and toward value-based network delivery to employees and their families, driven by timely data, cost efficiencies, wellness incentives and better-coordinated care.
But don’t expect an overnight cultural transformation among employees, according to Jim Patton, area vice president of the Mid-Atlantic region for Arthur Gallagher and Co.
Patton was the keynote speaker at the Future of Health Care panel program hosted by the Pittsburgh Business Times in partnership with UPMC Health Plan on May 14 at the Fairmont Pittsburgh.
“I wish you could just turn on a switch,” Patton said. “If you really want to get great results, it’s a three- to five-year education strategy, buy in from leadership, full-court press every day, walking, talking and believing in the message and delivering that message to the employees to where the culture changes. … They have to understand the big picture.”
He said employees have seen dramatic increases in health care costs with traditional health plans and, at the same time, have deemed other benefits such as time off and flexible schedules more important, leading to talent recruitment and turnover challenges for employers. One of the biggest hurdles? Getting employees to change their health care attitudes and behaviors.
“This year, attracting and retaining talent – by far – is the No. 1 challenge employers have,” Patton said of the current benefits environment. “In some industries, people will leave for a dollar an hour more. They don’t even care about the benefits plan. They just want the cheapest plan money can buy. The medical plan isn’t what it used to be. Employers need new solutions.”
And that’s where the value-based health care network comes in, according to Patton, who added that it’s important to work with current data, employees and providers to create a cost-efficient network of coordinated care that includes a proactive wellness strategy, incentives for participation, compliance with regimented treatment, and options such as telemedicine versus urgent care or hospital visits and mail-order versus retail pharmacy.
Dr. Stephen Perkins, chief medical officer, commercial and Medicare services, at UPMC Health Plan, and the moderator of the event, said that “Collaboration and communication among the insurer, patient and providers, and outcome measurements that have performance-based payments – this is the winning combination to drive employees to become more engaged in their health care and make decisions and effectively boost their understanding and savings eventually to the employer.”
John Mills, senior director, commercial products, UPMC Health Plan, said the data in particular are important to help keep employees in compliance with medication and treatment regimens.
“So far, our product has performed significantly better, with 7 percent to 8 percent lower medical [costs] and 5 percent lower pharmacy [costs], and it’s really attributable to the better care coordination and outreach that we’re doing,” he said.
So what do employers need to do to get their employees to embrace a value-based network plan that requires active engagement, potentially significant changes in behavior and compliance with wellness initiatives?
“What you have to realize when you make this shift is that this is an immense culture change,” said Mary Hawley, director of human resources at the North Allegheny School District. “This is a heavy lift and has to be looked at holistically throughout the whole system. We have a workforce that was very accustomed to wanting the best benefits at the lowest cost, and they really didn’t want to have to do a lot of work.
“So we had to build this into our strategic plan,” she continues. “We had to do a lot of education up front. Three years in, the results that we are seeing are really proving that this is the direction we need to go.”
As part of the district’s value-based network plan, Hawley said, the district implemented a “branded” wellness initiative to get buy in from the workforce, including the training of “champions” across the district and a new recognition program to showcase employees who have significantly changed their health care behaviors.
Date: May 17, 2019