Is your wellness program worth it? Only a defined ROI can tell.

Wellness programs have been around for decades. But, they became a household name in many corporations after the Patient Protection and Affordable Care Act of 2010, which allowed employers to provide financial incentives to encourage participation. Since then, the definition of a wellness program has been so misconstrued that initiatives are money wasters more often than they are money savers.

Here’s the breakdown:

  1. Most wellness programs incentivize employees to participate in a health risk assessment (HRA) and a biometric screening in exchange for stagnant premiums.
  2. Employers consider their total investment (program cost plus incentives) worth it if it results in happier, healthier, more productive workers. This can be measured in many ways, from decreased absenteeism to employee stress level improvement.
  3. But the original intent and actual value of a wellness program is cost containment, where premiums are not increasing drastically and unpredictably year over year – impacting the wallet of the employer and employee alike.
  4. A wellness program by definition is something that supplements acute care utilization and does not hit the primary care expenditures. In other words, participants are able to avoid tapping into their health insurance for basic medical-related needs.
  5. An HRA and biometric screening approach does nothing to prevent employees from utilizing acute care or primary care. In fact, biometric screenings have led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year.

In order for a wellness program to truly work in that it is providing protection from increasing health care costs, employers need to do two things:

  1. Bring transparency in health care to employees just like we have experienced in every other industry.
  2. Clearly define the ROI in terms of decreased health care utilization so you can directly quantify how your workforce is effectively navigating their health and the health care system.

How to clearly define an ROI

Don’t look at the employee participation level and count that as an ROI. Don’t think just “getting healthy” is an ROI either. Employees need to become better consumers of the health care system if a business is going to be able to manage health benefits and employees are going to save on out-of-pocket costs. Trust us — you’ll still end up with a healthier, happier workforce as a result!

Following are areas where employers can start to define the ROI of their wellness program.

  1. Deductibles – Are employees groaning about out-of-pocket costs until they meet a high deductible? Is there a mad dash in the beginning of the year to spend it so anything that happens the rest of the year is covered? Helping employees understand that purposely not hitting their deductible means a lower utilization of the insurance coverage and a refunded premium. An ROI doesn’t get more defined than that.
  2. Prescriptions – Walgreens and CVS aren’t the end all be all of prescription fills. If employees have access to information about the prescription and its generic counterparts, who carries it, and the cost difference between different providers, they can become more savvy shoppers that are taking care of themselves and their budgets.
  3. Independent Providers – Studies prove there is no correlation between quality of care and the cost of care. Especially when it comes to imaging services, lab tests, and general medical questions. Utilizing these out-of-hospital resources gets employees the care they need while saving employees and employers considerably on claims and benefits renewals.
  4. Cost Transparency – Tools, resources, and patient advocates that can help employees understand the cost implications of everything they utilize in health care — from Tylenol in the maternity ward to open heart surgery — make employees better equipped to make smart decisions.
  5. Restoring the Identity of the Patient as a Consumer – No cost containment and health management program is successful without educating the employee to be in control of their health and a true, confident consumer of the health care system. This requires a balance of heeding the advice of medical professionals, following medical standards, and seeking treatment and care in a way that is most efficient and cost-effective for the individual.

At the end of the day, the employer needs access to a tool that can help them understand how employees are utilizing the health care system and how often they are tapping into insurance. For example, if an employer could quantify that visits to acute care centers decreased among the employee population by 40% in one year, that is a real cost savings that can be used to benefit the entire company. To accomplish this, employees need access to price and provider transparency tools to help them make decisions.

Herus Group is excited to be the exclusive Midwest provider of a new product offering that wraps employee and employer tools all in one, easy to use website and mobile app. It’s called HealthWallet.

Changing the way health care is managed

We’ve reviewed and implemented many wellness programs and third party patient advocate platforms. HealthWallet is the only provider that keeps all health insurance information in one spot and works with all health insurance carriers:

  • Insurance card information
  • Personal health profile
  • Health log
  • Primary and secondary care contacts
  • In-network providers
  • Claims
  • Visits
  • Coverage

It also provides discounts and services:

  • Cost comparison – For in-patient, out-patient, and prescriptions at locations nearest the employee making sure they are getting the best price and deepest discount available. This can be done manually or through geo-fencing to provide real-time advice on more cost-effective options.
  • Out-of-pocket estimating – Helping employees calculate co-pays, understand deductibles, and know the cost implications prior to the health visit.
  • Telemedicine – Talking with licensed medical professionals via phone or video conference to address minor needs or get advice on care. Telemedicine can accommodate 70% of the reasons why employees seek primary care. And it’s free with the HealthWallet program.

The hardest part about adjusting the structure of a wellness program is selling the culture of consumer-driven healthcare. It’s a culture where employees are aware of their health risks, room for improvement, productivity at work, energy at home, stress levels, but they combine that with knowledge of when they need primary, urgent, and acute care, to save real money on health care costs. It’s a culture that changes the way health care is managed.

If your wellness program doesn’t have a clearly defined ROI, or you want to implement a wellness program with the goal of cost containment, contact Herus Group today to see how simple it can be.

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