NEWS & TRENDS

EMPLOYERS SHIFT FOCUS TO MANAGING DISEASE

Recognizing that a minority of people generate the majority of medical expenses, employers are getting serious about disease management for chronic conditions like asthma and diabetes as a cost-control mechanism.

The Center for Studying Health System Change reports that health plans are expanding their disease management offerings, increasing outreach activities to help boost member participation and using predictive modeling to identify patients likely to generate significant health care costs. Large employers are customizing programs for the most prevalent and costly conditions specific to their workforce.

Other surveys confirm that the plans are responding to their customers' demands: The Kaiser Family Foundation's latest Employer Health Benefits Survey found 22 percent of respondents labeling disease management as the most attractive strategy in moderating cost trends. The 2003 Deloitte & Touche/Business & Health Employer Health Care Strategy Survey reported that nearly one in four respondents makes disease management programs available to employees and their families — up from one in six in 2001. The proportion rises to 43 percent among very large employers with 10,000 or more employees. (Click here to read more on the D&T/B&H survey.)

While a number of reports have shown that specific disease management programs can improve patient care and reduce service utilization, most DM experience is still too preliminary to prove a return on investment. Due to high membership turnover, health plans are obviously more interested in programs that can produce relatively short-term reductions. Employers, on the other hand, can better gain from long-term reductions in absenteeism and work-related injuries, as well as increases in worker productivity and satisfaction.

Don't miss this issue's feature article on the case for immediate implementation of disease management programs.

Roughly 41 million sick days, 57,000 deaths and $11 billion in lost productivity could be avoided annually if "best practices" were more widely adopted, reveals the recent State of Health Care Quality report from the National Committee for Quality Assurance. NCQA blames the quality gaps on factors like poor use of technology and irrational payment systems.

WORRIES RISE WITH UNINSURED RATE

One in five Americans view health care as the most critical issue in the country today, second only to the economy at 27 percent and slightly ahead of terrorism and national security at 17 percent, says the 2003 Health Confidence Survey from the Employee Benefit Research Institute.

Almost half of Americans (44 percent) are unhappy with health care costs, a 12 point rise from 1998. And more than a quarter (28 percent) rate the current overall health system as poor, almost double 1998's 15 percent. Of those with employer-based coverage, only 61 percent are confident their employer will continue providing benefits, down from 68 percent in 2000.

Reinforcing these concerns is the largest rate of uninsured Americans in a decade. New figures from the Census Bureau blame a decline in employer-sponsored health insurance for pushing the number of uninsured Americans to 43.6 million Americans in 2002. That's 15.2 percent of the population and an increase of 2.4 million from the previous year. No real surprise here: Rising costs make it harder for small businesses to offer coverage and less likely that low paid employees will be able to afford their share of premium. Stubbornly high unemployment rates mean loss of benefits, straining programs like Medicaid as states struggle with burgeoning overall deficits.

Help from Washington is unlikely in the immediate future. Medicare — especially a prescription drug benefit — is the political priority, while tax cuts and war spending have created record deficits that preclude major action on health.

Fifty percent of business travelers need two full days to catch up on work responsibilities, and another 12 percent need three days, according to a recent study from Kensington Technology Group. Other findings: 55 percent say they spend too much unproductive time traveling to and from airports, 41 percent are stressed by time wasted in airport security lines, and only 39 percent actually use laptops to do work while in the air.

WAL-MART: THE FUTURE OF HEALTH CARE?

Forget about rollin' back prices. These days the retail discount giant Wal-Mart is making news for cut rate health benefits. According to a recent Wall Street Journal article, Wal-Mart spends an average of just $3,500 annually per employee on health coverage, roughly 40 percent less than the average for all U.S. corporations. How do they do it? With a bare bones strategy.

Wal-Mart eschews preventive care and focuses on catastrophic coverage. The company's main goal is to ensure that its employees don't go bankrupt in a medical emergency such as cancer treatments or organ transplants. The rules are tough: Employees must wait six months to sign up for benefits. Deductibles can hit as high as $1,000. Flu shots, eye exams, child vaccinations, chiropractic services and other fairly standard treatments offered by other companies are not covered. Retired employees aren't covered at all. On the other hand, hospital care and other major medical expenses (such as organ transplants) are covered generously.

Helen Darling of the Washington Business Group on Health predicts that rising costs will force more employers to head in this direction in the foreseeable future.

Over 60 percent of brokers feel consumer-directed health care is at least two years away from gaining any real ground with employers, reveals a new study from the National Association of Health Underwriters. Currently only 12 percent are actively recommending these plans to clients.

News & Trends.

Business and Health

Oct. 15, 2003;21.