Health spending Though the economy is rebounding, still-rising health costs are forcing employers to rethink health benefit plan designs.

According to a survey by the National Business Group on Health, 60 percent of employers will increase the employee share of health benefits costs this year.

While a handful of employers plan not to offer health plans to employees anymore, others have begun increasing premiums, or are replacing flat co-pays with cost-sharing or offering high-deductible plans coupled with health savings plans in order to keep offering employee benefits, says Michele Woodham, director of agency operations at Odyssey One Source, a human resources outsourcing company.

Jim Mutz, director of benefits services for Odyssey One Source says that employees know “everyone is in the same boat” and have countered increases by contributing more to flexible spending accounts, dropping ancillary benefits and maximizing employer contributions. In order to avoid paying increased premiums, many employees are also choosing to go with the higher-deductible plans with HSAs to help pay for health care costs.

George Pantos, the executive director of the Healthcare Performance Management Institute, a Maryland-based think tank, says he believes the key is to find ways for companies to control cost increases in the first place.

“Cost shifting is not cost control,” he says, noting that employees have to pick up the difference, which can have a big effect on employees’ salaries and lifestyles.

George and his company conduct research help companies find ways to trim costs, by using “healthcare performance management.” HPM is basically software technology that uses health data to identify those in a workplace population with chronic, high-cost conditions such as obesity, diabetes and high blood pressure.

Using this data, such as how many times an employee went to the doctor in the last year or what their medication claims were, employers can identify proactive ways to help employees with these high-cost conditions, which in turn help curb costs. And, because it doesn’t single out any one employee with a health condition, it doesn’t conflict with HIPAA.

One proactive idea is to create wellness programs like exercise groups or health seminars to inspire and show employees ways to become healthier, which would eventually lead to a decrease in health claims. Case studies have shown that when employees are offered a financial incentive to participate in wellness classes, about 80 percent do so.

To demonstrate just how much a company can save by implementing HPM strategies, George cites The SCOOTER Store case study, which saved more than $2 million in health-related costs from 2009 to 2010.

The SCOOTER store, founded in 1991, sells powered wheelchairs and scooters and employs about 2,800 employees. Deanna Scott, vice president of human resources for The SCOOTER Store said the company’s claims were skyrocketing, and realized they needed a different approach to combat costs.

“We needed to focus on illness prevention, as opposed to just paying for what’s already happened,” she says.

The first thing they did was put in a free, on-site gym for employees. The momentum from this spawned the company’s branded wellness program, “Live, Work, Be Well” which is sponsored through Wellnet Interactive and Personalized Prevention.

A Wellnet Interactive HPM system was put into place, which used prescription and medical claims data to indentify high-risk employees. WellNet then reached out to employees with ways in which they could lower those health risks.

The SCOOTER Store also added a full-time on-site clinic for employees, where employees don’t have to pay a co-pay to be seen by a doctor.

Scott says year-over-year employee health costs went down 22 percent in 2010, a savings of $2.3 million.

Health care reform is another concern for employers worried about employee benefits.

“Employers are genuinely concerned. There is so much unknown until 2014,” said Woodham.

Mutz says no one knows if health care reform is really going to reign in costs.

Jeremy Sharp, partner at Walter and Haverfield in Cleveland says that while we are in health care reform limbo, employers should be working to improve efficiency down the road.

One good outcome of health care reform, he says, is that as people see it in the news every day, they’ve begun to think more about their own health. Employees have “now come to appreciate that they have a stake in health care,” Sharp says.

Sharp believes that health care reform, once fully phased in, will lead to stabilized costs, especially if healthy people are required to pay into the system under the individual mandate.

The issue is what to do in the meantime. He says the most common question he gets from employers is “What do I do?” Sharp also advocates implementing wellness programs. He says offering programs such as a lunch-time walking club for employees not only can improve employees’ health; they also create happier employees.

“They talk about work, and they come back to the office feeling more energized,” he said.

Instant Insights /

In cost-shifting equation, wellness could be the answer

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