Managed Care - May 2008 - (Page 52) PLAN WATCH Focusing on consumer pays off Aetna earlier this year released a study to show how utilization and claims costs for members in its Aetna HealthFund program decreased. Six employers, in particular, experienced extraordinary results: a combined employer and employee savings of $1,500 per member over four years. Aetna says that the six employers fully embrace what the insurer calls the four keys to a successful consumerdirected effort: offering wellness programs, fostering a consumer culture, conducting employee education and communication campaigns, and constructing a benefit package that includes appropriate levels of member responsibility. Owens Corning, one of the companies that has had the most success with this program, stresses 100-percent coverage for preventive care and rewards for healthy behaviors and for completing a health risk assessment, says Mark Snyder, director of employee health, wellness and benefits at Owens. “This is a continuous effort,” he says. Aetna President Mark T. Bertolini says that “the payoff is significant for those who embrace all the tools that influence health care consumerism.” Companies see savings $300 10,000 employees over four years, according to a study released in January. Aetna says that the six employers fully embrace what the insurer calls the four keys to a successful consumer-directed effort (See box at left). Downey admits that much of what is in the four keys consists of “no-brainers.” The success of Aetna HealthFund, in fact the only way it can work, is through commitment of upper level management. “These companies got their senior leadership involved in discussing with their employees what impact health care costs have on the bottom line,” says Downey. This is quite a change for many executives used to considering their health plans as something the human resources department handled automatically each year. Communication in Aetna HealthFund needs to extend far beyond the open enrollment period, Downey stresses. “For most employers, especially the larger ones, providing health benefits is probably the second biggest expense a company has,” says Downey. “So why do you only talk about it when you do open enrollment?” $274 Expected claims PMPM $250 $200 $227 Actual claims PMPM $150 $100 $50 0 Pre-Aetna HealthFund (2002) Source: Aetna Savings $47 Year 1 (2003) Year 2 (2004) Year 3 (2005) Year 4 (2006) Chronic conditions The CDHPs are not just for the healthy, she adds. “You can also be somebody who has chronic conditions, but is managing them. You’re diabetic but it’s under control. I’m taking good care of myself. I’m doing what I need to do. I have this condition. I have to take drugs. Or maybe I take such good care of myself I don’t have to be insulin-dependent. It’s really focusing on the wellness aspect of someone who has a chronic condition.” Downey says that companies need to bestow concrete rewards for healthy behavior. “Reward them for taking a health risk assessment; that will give the health plan an idea of what the employee’s overall health status is. I’ll reward you, if you take the health risk assessment, with maybe $25 to $100. It’s not money that they’re just going to give you a check for. They’re going to put it into your HRA or your HSA account.” MC 52 MANAGED CARE / MAY 2008
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