If you have any questions, please call us at (281) 809-6960 or email us at HBCHmembership@HoustonBCH.org

HBCH Connect Winter 2016 Print

Message from the Executive Director

HBCH Executive Director, Dr. Chris Skisak, outlines 2016 plans. Best wishes for a happy, healthy and productive 2016!  I am excited about what we can achieve in 2016 as a community.  In a little more one and a half years we have grown to represent   71 organizations, 300,000 local employer lives and more than 1 million nationally.  I visited with scores of Houston employers in 2015 and will continue to reach out to all of our stakeholder organizations.  That said, I want to encourage all members to contact me with suggestions on how HBCH can improve our value to your organization.  We may be able to assist you in ways that are not obvious through our current programming or resources.  I am constantly reminded that employers of different size often require different strategies to achieve improved outcomes in the cost, quality and employee experience in health care benefits design and delivery.  Toward that end and consistent with our mission, I am excited with the diversity of employer size represented in our organization and on our 2016 Board of Directors.   We will continue to provide actionable educational programs of which there will be 6 in 2016.  New in 2016, HBCH will be hosting a variety of roundtable discussions intended to provide open dialogue among employers based on size, industry and issue.  HBCH will also form several new committees (Membership, Programming, and Communications) and will be looking for leadership volunteers among our membership.  Our ability to impact through collective influence can only be realized through active participation of our health stakeholder community.  We hope you stay or get involved in 2016!  

 

Chris Skisak, HBCH Executive Director

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HBCH Expands Board of Directors

 

Several 2015 HBCH Board members will be ending their term. I, our Board and our membership thank them for their leadership and support as HBCH was getting off the launch pad.  Board members cycling off are Mario Di Blasi (Aetna), Henry Noey (AON), Michael Tucker (Towers Watson) and Gerri Walker (City of Houston).  The composition of the 2016 Board will reflect its employer-centric mission.  It will consist of 15 members and will include 11 Employer and 4 Associates (providers of health services).  We will have a representative mix of employers from all sizes and industry types.  We will also have a mix of Associate members on the Board representing health plans, pharma, IT population health management platforms and benefits consultants.   HBCH will begin the year with the 11 Board members listed below but expect to name a few more this year.

 

 Becky Brosche  Pfizer  National Director Employers
 Lou Cooper  Castlight  Regional Sales Manager
 Mark Christensen  MetroNational  Director of Human Resources
 Karl Dalal (Chair)  BP  Director, Health & Protection Programs
 Suzan Gutzman  The Friedkin Group  Senior Benefits Administrator
 Ann Hollingsworth (Treasurer)  Memorial Hermann  Vice President, Comp., Benefits & HRIS
 Valerie Hulse  KBR  Vice President, Global Comp., & Benefits
 Sheri Lytle  Silver Eagle Distributors  Vice President, HR & Risk Mgmt.
 Jason Mahler  AON  Vice President
 Tom Stewart  Blue Cross Blue Shield  Vice President, Sales & Client Mgmt.
Bethany Spurrier  Stewart & Stevenson  Benefits Director
Jocelyn Wright  City of Houston  Asst. Director, Human Resources

 

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2015 Texas Employers Worksite Wellness Survey Results

Statewide and Houston area results on employer wellness programs are available to download. How does your company’s wellness program measure up?  One of HBCH’s collaborating organizations, the Texas Business Group on Health, partnered with the Texas Department of State Health Services this past fall to conduct a benchmarking survey that generated a snapshot of employer-sponsored wellness programs in Texas. A total of 281 employers from all sizes and industry types responded including 54 Houston area employers.  The survey benchmarked key wellness component strategies including physical activity incentives, healthy eating, diabetes management, tobacco & smoking policies, obstacles to employee engagement and key metrics used to measure success.  Please click here  to download the Texas and/or Houston region complete reports.

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2016 Member Interest Survey Shows Consistency of Houston Health Benefits Concerns

Are your health benefits concerns in line with those of other Houston employers? HBCH conducted its 2016 Interest Survey among members and prospects in the fourth quarter of 2015.   The survey requested input on general and specific program content based on current “Pain Statements” in health benefits design and delivery.   HBCH will address all of these topics in our 2016 programs and roundtable discussions.   The top challenge in 2016 for employers remains cost containment.  Cost containment was targeted towards pharmaceutical pricing, high costs claimants, and concern about the ability to continue to provide benefits that are competitive and of value to employees.   Another major “pain statement” among employers is a lack of employee engagement in health.     

The top general program area that employers would like HBCH to address is Employer Benefits Strategies to Bend the Cost Curve & Impact Health Outcomes.   Rounding out the top five are Integrated and Actionable Data to Improve Cost & Quality, Employer Transparency & Consumerism Tools, Specialty Pharmaceuticals Cost Containment and Employee Wellness.  

Employers requested program content for each of these general topics and the top vote getters shown below.

Employer Benefits Strategies to Bend the Cost Curve & Impact Health Outcomes: HDHP’s, CDHP’s and Their Impact on Health Engagement Outcomes; Narrow Networks / High Performance Networks / Centers of Excellence; and Employer Direct Contracting for Health Services

Integrated and Actionable Data to Improve Cost & Quality: Use of Actionable Data to Guide the Design of the Health Benefit Strategy

Employer Transparency & Consumerism Tools: Employee Health Engagement Applications and Devices; and Physician & Hospital Cost & Quality Selection Tools

Specialty Pharmaceuticals Cost Containment: An Employer’s Guide to Specialty Pharmacy; and Medical Plan, Pharmacy and PBM Opportunities

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New Houston Mayor, Sylvestor Turner, Discusses His Approach to Impact Obesity

The University of Texas School of Public Health notes that obesity is a disease that serves as a gateway to diabetes, stroke and numerous other serious health complications. They also note that obesity is a public health issue because it has reached epidemic proportions, affecting more than a third of our community. Are you willing to use the Office of Mayor to produce billboards and other forms of communication (print material, social media, newsletters, etc.) to disseminate the following public service message? “Warning: Obesity is a disease that is hazardous to your health.”

Sylvester Turner: Obesity is a serious and growing public health issue with disproportionate impacts on our most vulnerable communities. I believe that a holistic approach, involving not only top-down messaging but also community input and participation, is the only way to effect lasting improvements. I especially am impressed with the success of Oklahoma City in combining a citywide weight-loss challenge, a true commitment to investment in walkable, bikeable infrastructure, and a public education campaign to make significant obesity rate improvements that have stood the test of time. As mayor, I will work to see if a similar model is right for Houston.

All 56 members of the Texas Medical Center are working on obesity. Most institutions are color-coding (red, yellow, green) the high-, medium- and low-calorie items in vending machines and cafeterias. Are you in favor of this approach for the City of Houston and would you work to implement it? How?

Sylvester Turner: Again, I believe a holistic approach is key. Color-coded vending machines are one way of ensuring that Houstonians have clear and easy access to information that will help them make the healthiest snack choice. But more must be done to engage and inform the public if we are to see lasting change in our obesity rates.

Would you convene a Houston CEO summit to address the obesity epidemic within your first 100 days of office? If so, why? And if not, why not?

Sylvester Turner: Effectively addressing obesity will require engagement from a variety of stakeholders, including Houston’s major employers. Partnering with the private sector to reduce obesity is not only good for the health of Houstonians, but for our local economy. I look forward to engaging with Houston’s CEOs on ways to improve our city’s overall health.

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Employee Engagement in Wellness Programs Still Difficult for Employers

BOSTON — Employers are struggling to connect workplace wellness programs and incentives to the wants and needs of their employees, according to a new study.

Half of the 1,669 employees surveyed by Towers Watson & Co. and the National Business Group on Health earlier this year did not participate in a single wellness activity or program in 2014, according to results released on Monday at the NBGH's 29th National Health, Productivity and Human Capital Conference in Boston.

Among the most popular wellness programs offered by U.S. employers — including health risk assessments, biometric screenings, onsite vaccinations, well-being fairs, and worksite diet and exercise activities — average employee participation rates topped out at just 48%.

Financial incentives also appear to be falling short of their intended targets, according to the survey. Employers said they offered an average maximum annual incentive of $880 per employee, but paid out an average of just $365.

“What's even more startling is that 40% of employees didn't receive any of the incentives at all. They completely opted out of the programs,” said Shelly Wolff, New York-based senior health management consultant at Towers Watson. “Employees are leaving a ton of money on the table, and that tells us that you can't pay people to change health habits.”

Ms. Wolff said the employee uptake rate for financial wellness incentives has actually fallen in recent years, despite employers steadily increasing the amount they offer in incentives.

“I think part of it is that people give up,” Ms. Wolff said. “They feel like it's too hard or not worth it, or that it adds unneeded complexity to their lives. Whatever the reasons, it's a big disengagement number.”

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On-Site Health Services Can Reduce Employee Absence and Comp Costs

Offering on-site health services is not likely to have a material impact on employers' medical expenses, but it can be useful in reducing employee absences and workers compensation costs, according to a report by the National Business Group on Health and Truven Health Analytics.

In a study of 107 large employers' health care, workers comp and disability benefit strategies the availability of on-site health clinics was shown to have little influence on group health insurance costs. It was conducted between April and June 2015 and released to members on Wednesday.

Employers that offer on-site clinical services reported per-employee health care costs of $10,277 on average, compared with $10,239 for employers that do not offer on-site clinics.

Sixty percent of employers polled in the study said they offer some form of health care services at their worksites, with 48% indicating that they offer acute care and 33% offering occupational health services.

“It's important to note that it has traditionally been difficult to connect the availability of on-site health clinics with lower overall health care costs,” the study's authors wrote in their summary report. “However, on-site clinics offer multiple benefits, including better care, improved access to care, and increased productivity, because employees do not have to leave the worksite to receive care.”

According to the NBGH's study, employers that offer on-site clinical services to their entire employee population reported an average incidental absence rate of five lost workdays per employee per year, compared with rates as high as 27 lost workdays among employers that offer minimal or no access to onsite clinics.

Nonclinical on-site health resources were also shown to be of some financial value to employers.

Companies that offer onsite workplace fitness programs, for example, reported average workers compensation costs of $323 per employee, 21% lower than the average per-employee workers comp costs reported by employers that do not offer on-site fitness programs.

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Economists Rethinking High Deductible Health Plans

Vox and the Healthcare Financial Management Association (HFMA) report on a new National Bureau of Economic Research (NBER) study that is forcing economists to rethink High Deductible Health Plans (HDHPs).

In 2006, about one in 10 employees had a health insurance deductible over $1,000. Today? About half do.

To health economists, this sounded like good news; they've long theorized that higher deductibles would force down health-care costs. The idea was that higher deductibles would make patients become smarter shoppers: If they had to pay more of the cost, they'd likely choose something closer to the $1,529 appendectomy than the $186,955 appendectomy (yes, some hospitals really do charge that much). This would push the really expensive doctors to lower their prices so cheaper physicians didn't steal their business.

This was, however, just a theory. And a massive new study suggests it might have been all wrong.

Economists Zarek Brot-Goldberg, Amitabh Chandra, Benjamin Handel, and Jonathan Kolstad studied a firm that, in 2013, shifted tens of thousands of workers into high-deductible insurance plans. This was a perfect moment to look at how their patterns of care changed — whether they did, in fact, use the new shopping tools their employer gave them to compare prices.

Turns out they didn't. The new paper shows that when faced with a higher deductible, patients did not price shop for a better deal. Instead, both healthy and sick patients simply used way less health care.

"I am a little bit surprised at just how poorly patients were able to do when looking at very similar products, like MRI scans, and with a shopping tool," says Kolstad, an economist at University of California Berkeley and one of the study's co-author. "Two years in, and there's still no evidence they're price shopping."

This raises a scary possibility: Perhaps higher deductibles don't lead to smarter shoppers but rather, in the long run, sicker patients.

Kolstad and his co-authors looked at the case of a large, unnamed company that shifted more than 75,000 workers and their dependents from a plan with no deductible to one with a $3,750 deductible. When the change happened, workers received a $3,750 subsidy to a health savings account — money they could spend freely on whatever health costs they incurred. The company also gave workers online tools to look up prices for doctor visits, tests, and other services they might need.

Workers' health spending dropped, and did so quickly. Average per-patient spending fell from $5,222.60 in 2012 to $4,446.08 in 2013. That's about a 15 percent decline in a single year — and it held true across all types of health services. Between 2012 and 2014, there was a 25 percent drop in emergency room spending, an 18 percent decline in physician office visits, and a 6 percent decrease in mental health services.

In one sense, then, the high-deductible plan did accomplish a key goal: lower health spending. But when the researchers looked at why spending dropped, they found it had nothing to do with smarter shopping. The average price of a doctor visit wasn't dropping.

Instead, under the high-deductible plan, workers just went to the doctor way less. The paper finds that "spending reductions are entirely due to outright reductions in quantity." Workers did use less "potentially wasteful care," like imaging services, but they also cut back on "potentially valuable care," like preventive visits.

Even more striking: The sickest workers were those who were most likely to reduce their use of care while still under the deductible — even though this is the group that needs lots of care and is most likely to blow through the deductible by the end of the year. Once these sick workers actually exceeded their deductible, though, use of medical services rebounded.

"People who are the most likely to go past the deductible also cut back by the most, and they did that entirely under the deductible," Kolstad says. "They respond to the spot pricing [the price of receiving care right then], and that leads to a very large reduction in care. We don't find any evidence they look for a lower cost. They just don't go."

This was the point, to me, that was most baffling in this new paper. Sick patients would likely have some sense that they needed a lot of medical care — and that they were probably going to hit their deductible. So why did they reduce the care they received in the start of the year instead of ponying up the costs, hitting the deductible early, and getting the care they thought they needed?

In some cases, you could chalk this up to a liquidity issue: A worker might not have enough money in her checking account to pay for all the care below the $3,750 deductible. But that explanation doesn't work here: In this case, the employer put a $3,750 subsidy in workers' health savings accounts.

Why wouldn't this group get the care they wanted, pay for it with the HSA, and just run through the out-of-pocket spending earlier in the year? Or, if they do want to reduce spending, why wouldn't they at least shop for a lower-cost provider instead of forgoing care altogether?

Kolstad doesn't have a definitive answer to this question, but he thinks it might have a lot to do with the difficulty all of us have, as patients, guessing how much we'll spend on health care in a certain year. This leads us to be more averse to upfront spending.

It's possible that even when we're sick, we tend to be optimistic. We might hope that our care costs less this year, and that maybe we'll even be able to roll some of our HSA account funds over to the next year.

"This is a difficult task for consumers to take on, and we now have very detailed data to show that's the case," he says. "When we've thought about the economics, we've generally thought this type of price change wouldn't be problematic, that sicker people would just spend their deductible and get the care they need. This research suggests that's not the case."

One study a few years ago, from the Altarum Institute, showed that Americans tend to spend more time shopping for dishwashers than for doctors — despite the latter being a rather more consequential decision.

 

For one thing, most of us don't have access to tools that would let us shop for doctors. I can go on Amazon and pull up prices for dozens of different dishwashers. But there's no website I can hop on, right now, to find out what different radiologists around Washington, DC, would charge me for an X-ray.

This study tried giving workers both the tools to compare costs and a financial incentive to go with the less expensive option. And, at least in this instance, those nudges weren't enough to encourage patients to choose cheaper doctors. Instead of looking for a lower-cost option, workers simply decided not to go to the doctor at all.

For Kolstad, this makes him skeptical of "demand-side" interventions in health care — those that rely on consumer demands for lower health prices to ultimately lead to less medical spending.

What's more, interventions that reduce demand could have the unintended consequence of actually raising long-term health-care costs. Think of the sick worker in a high-deductible plan who forgoes care in the early part of the year. It's possible that skipping preventive care or not filling some prescriptions could worsen health conditions that necessitate costly interventions a few years down the line.

This study only looks at two years of a high-deductible plan, and in that time period it doesn't show this theory bearing out. Still, Kolstad says it could be a long-term possibility that we just don't have enough data to know about yet.

"It's certainly plausible you'll see the cost changes later," he says. "That could manifest in lower productivity on the part of the worker, if you have people with worse health status. Those are long-run changes, but they are definitely a possibility."

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Health and Productivity Management Employer Case Study

OVERVIEW

Hackensack University Medical Center responded to challenges of high levels of employee absence that severly impacted operating costs, employee productivity and morale by integrating their health benefits offerings. When rolling out the integrated initiative, the company found that a step-wise approach has several advantages: launch key cost-management platforms first, then test additional components in pilots, allowing longer periods to achieve employee acceptance.

Click here to view the full report.

 

 

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HBCH Upcoming Events

March 9 - The Specialty Pharmaceuticals Dilemma, Opportunities for Employers

April 6 - The Real Value Proposition of High Performance Networks, Narrow Networks, and Centers of Excellence

May 12 - Effective Clinic Models for Employers of All Sizes to Improve Health Engagement

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Upcoming Collaborative Events

January 27, 11:30 am – 2:00 pm: Texas Business Group on Health, Westin Galleria, Dallas, TX

The Value of Data - Financial and Non-Financial Measurements.  Today, companies have a wealth of data available - that can and should drive decisions.  This program will provide attendees with ways to measure the impact of health benefits programs from financial and non-financial perspectives (read more and to register).  HBCH members can register at the TBGH member rate.

 

February 15-17: Integrated Benefits Institute Annual Forum, The Westin St. Francis, San Francisco, CA.

HBCH Employer Members Attend at No Cost, but the free slots are limited so apply now!  The 2016 IBI Annual Forum will convene more than 430 employers, suppliers, and other thought leaders to explore innovative solutions to the myriad challenging and ever-evolving issues in the health, wellness, and productivity space. Read more.

  

5th Annual Tia Chi in Hermann Park Community Health Challenge, All Saturdays in March

Living Well Therapies and Reason2Race will host this healthy, fun, and win-win event for all.   Participants raise funds and increase awareness for nonprofits.  Nonprofits make a healthy difference for our community. Sponsors make a healthy difference for our nonprofits and their brand (read more).

 

 

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