HUMAN Capital - Fall 2015 - (Page 24)
Human resources and
bY aNDrea SHaNDro, Co-PrINCIPal, VITal ParTNerS INC.
benefits renewals and reporting can provide a window into employees' health and
health habits. Human resources teams
frequently look at this information with
a lens of explaining benefits costs, premium increases or decreases and future
trends. Some renewal reporting, available for employers with more than 10-20
employees, can provide data that plan
sponsors could turn into measures that
could potentially reduce benefits costs.
but how can renewal information be
transformed into action? and how do
you take action on that information without breaching the confidentiality of a
particular employee or their dependent
Health and dental utilization reporting
is designed to ensure that employees'
health information is confidential, which is
why insurers do not provide specific data
for groups with fewer than 10-15 employees participating in the plan. otherwise,
the plan sponsor or business owner might
be inclined to try to identify an employee
who is accessing massage treatments or
who is being treated for a particular condition and treat him or her differently.
Here are some areas to consider when analyzing your benefits renewal information.
drug utilization reports
Drug utilization reports are broken down
into several categories. Insurers will often
provide reporting according to the top
drugs claimed by total cost, by number of
scripts, and by therapeutic classification.
24 | www.hria.ca
Consider a wellness program: The
number of scripts or prescriptions can
point to conditions or symptoms that are
widely being treated in your organization.
large numbers of prescriptions to treat
high blood pressure or high cholesterol
might be reduced with the introduction
of a wellness program.
tackle dispensing fees: If you notice that
the number of prescriptions is increasing from year-to-year, you could provide
education regarding dispensing fees.
encouraging employees to access the
pharmacy at Costco or other lower cost
providers could save each time a drug
is dispensed. (Please see sidebar "2015
average alberta Dispensing Fees,"
prepared by Vital Partners Inc.)
Some organizations choose to implement
a dispensing fee deductible or a dispensing fee maximum to induce plan members
to actively select a lower-cost pharmacy.
If employees have a $5 to $7 dispensing
fee maximum and had to pay an extra $3-5
out of pocket each time they purchased
a drug, they might be inspired to search
out lower-cost pharmacies.
Some insurers are implementing programs that are designed to encourage
active health care consumerism as well.
If a plan member purchases a drug from a
pharmacy inside a network, co-insurance
is increased (they would get 90 per cent
reimbursement instead of 80 per cent).
If they choose a pharmacy outside of the
insurer's network, the coinsurance level
would be lower.
In-network pharmacies also promise additional savings and services such as lower
than average prescription drug costs and
dispensing fees, in addition to free home
delivery service for maintenance medications used to treat conditions like diabetes
and high blood pressure.
Some plan sponsors are uncomfortable
advocating consumer behaviour for their
plan members. but pharmacy networks
are proving cost effective. The potential
savings realized through Great West life's
pharmacy relationship with Costco ranges
from 7.5-18 per cent of extended healthcare costs. Great West life estimates that
on average, group plans that have added
their pharmacy network value plan have
three times more prescriptions filled at the
in-network pharmacy than plans without
Plan design: looking at drug utilization
data in conjunction with the rest of the
plan design could also be helpful. With
many plan sponsors cutting paramedical practitioners to save costs in a volatile
economy, are the savings of reduced coverage for massage therapy being offset
with increased drug claims for pain relievers or muscle relaxants?
Mandatory generic: brand name drugs
are often highlighted in the reporting.
If your plan has not already moved to a
mandatory generic platform, take note
of the number of brand name drugs that
are being used by plan members and their
dependents. educating plan members and
their dependents about the importance
Table of Contents for the Digital Edition of HUMAN Capital - Fall 2015
Building for Success at Alberta Health Services
Fostering Collaboration and Consultation in Developing AHS’s People Strategy
AHS HR Service Delivery Model
Transforming HR in AHS
Implementing Organizational Change Adoption
Leadership Development and the LEA DS in a Caring Environment Capabilities Framework
Blurred Lines: Human Resources and Health-Care Information
HR’s Role in Creating and Maintaining a Psychologically Safe Work Environment
HR’s Response in an Emergency Natural Disaster
Index of Advertisers/ Advertisers.com
HUMAN Capital - Fall 2015