The U.S. Preventive Medicine wellness program, also commonly known as The Prevention Plan, is comprised of multiple intervention steps designed to spur employee awareness of their own personal health risks. Based on the findings from a detailed initial assessment, members are given a personalized prevention plan, access to innumerable online tools, and continuing coaching and support from a health advocate. The program has a strong engagement, motivation, and participation rate, especially when supported by employer incentives, regular communication, and a culture of health.
Study Highlights. The study of The Prevention Plan participants found that:
Many experts say that a large part of the severe health care cost crisis America is facing today is caused from the increased burden of chronic illness. Data from The U.S. Department of Health and Human Services is in line with this thought. The government agency estimates that preventable chronic conditions, such as cancer, heart disease, diabetes, stroke, and chronic obstructive pulmonary disease account, accounts for 75% of health care costs.
Health risks are also commonly identified as being the subsurface driver of increasing health care costs. Health risks play a part in health care cost because as increasing numbers of Americans are having their length of life and quality of life eroded by succumbing to avoidable lifestyle risks, they’re also increasingly utilizing medical services, which in turn places an economic burden on all of society.
Health risks and chronic illnesses also have a direct impact or burden on employers. Employees with poor health are likely to be less productive workers and have more work absences on their record, a combination that usually places a serious profitability drain on businesses.
One thing is clear to expert and novice alike: The trend of health care cost is simply unsustainable. According to a survey done by Kaiser Family Foundation in 2009, the average premium for family Health insurance is 131% higher than it was in 1999. This study might be the compelling scientific evidence that many need to realize that wellness, when structured atop prevention, can work.
The merits or dangers of evidence-based medicine notwithstanding, a recent study published on the website of the journal Health Affairs suggests that additional education on the consumer front is necessary before more Americans will accept the practice. The study was conducted between August of 2006 and December of 2007 and collected data based on popular consumer-oriented methods such as focus groups, online surveys and interviews. The team conducting the research project also interviewed a number of professionals, specifically forty employer intermediaries like human resources staff.
Since the recent healthcare reform law includes encouragement of evidence-based medicine, the release of this study is particularly timely. The majority of the participants in the focus groups stated a belief that EBM would impinge upon the patient’s freedom to choose treatment and result in medical practices becoming artificially rigid and unresponsive to patient needs. These participants wanted the freedom to make choices about their healthcare using both their physician’s judgment and their own about quality of care.
One notable participant even went on record as saying that evidence-based medicine was a method of protecting doctors from medical malpractice liability. Obviously, such a negative denial indicates that consumer education must become a significant priority for advocates of EMB. According to Dr. Kristin L. Carman, who is the co-director of health policy and research at the American Institutes of Research, the study demonstrated the need for consumer education to fill the gaps between EMB and consumer knowledge. The study also gave cause for optimism, however. A minority of participants understood and accepted the basic tenets of EBM and expressed a willingness to increase their level of participation with their own care.
The participants in the survey also revealed an interesting aspect: just 47% of those surveyed agreed that people should pay less out-of-pocket for the most effective medical treatments. A significant minority, 33%, also believed that the better a medical treatment is, the more it should cost. Importantly, an astounding 55% of respondents stated that they did not actively participate in their own medical care. For example, these 55% said that they never took notes during medical appointments, and 28% said that they did not come prepared with a list of questions to ask their doctor.
Long-term disability benefits are one area that seems to be especially important to many potential employees. The purpose of long-term disability coverage is to protect a worker should he/she become disabled and are no longer able to work. Although this is the premise of any long-term disability plan, employers should understand that all contracts are not equal in quality.
Of course, most employers are usually concerned with cost control. Many turn to the carrier to come up with a plan to manage risk. This most often entails benefit limitations for certain circumstances and/or incentives for the employee to speedily return to work. These two techniques are popular for a reason - they work to control premiums effectively and address risk exposure. That said, restriction and limitation techniques can have disastrous consequences for affected employees. For example, the plan description might read as though benefits are available until the employee reaches 66-years-old. However, if the contract limits the exact condition the employee is suffering from, then benefits could be cut short.
Considering the current economic state, many employers don’t have a choice but to keep premiums low if they want to offer coverage. In this case, it’s actually more sensible to go with a contract featuring lower plan maximums and benefit percentages, but fewer restrictions. The main concern should be to avoid surprises by making sure that employees know and understand the benefits before they actually need to use them.
One common source of employee confusion about their benefits is in the definitions. Employers should make certain that definitions, especially those of covered income and eligible employee classes, are written concisely. For example, an employer that’s planning to only cover certain grades or levels of their management team shouldn’t use catchall terms, such as management, to define covered employee classes. This might cause some employees to assume falsely that they’re covered. An employer should never make it so that an employee only finds that they’re ineligible for benefits at their time of need. The same should be said as far as earnings go. The employer should state exactly what employee earnings are and aren’t covered by the plan. For example, will bonus pay, incentive pay, and commission pay be covered?