How implementing an employer-sponsored wellness program is worth the gamble
It is no secret that a healthy population leads to lower healthcare costs. With higher prevalence of diabetes, heart disease and substance abuse within Native populations, it is also no secret that Tribal employers are struggling with how to improve health within their benefit-covered members. Wellness plans are one of the first topics brought up when discussing how to improve the overall health of your team members and dependents.
Wellness plans and programs can be tricky subjects when implemented within a Tribal environment. Most, if not all, Tribes have some type of wellness or disease management program(s) provided by the Tribe for Tribal members. If the employer-sponsored health plan also implements a program, this can lead to confusion and frustration.
Let’s first take a moment to discuss the different levels of wellness programs in the market:
Level 1 – Disease Management: Typically, disease management is lumped into the “medical management” bucket of a health plan; however, it’s important to also consider it as part of your wellness program, based upon its overall goal of increasing the health of the chronically ill. Disease management is most often a nurse-based program that will target and help manage individuals within your population who have certain chronic conditions, such as asthma, COPD, diabetes, coronary artery disease, etc.
Level 2 – Biometric Screening: These programs measure physical characteristics, such as cholesterol, blood glucose, and several other health indicators. These measurements are pulled from a blood sample (either venous draw or a finger poke). The idea is that an employer can incentivize the team members and dependents covered under the health plan to participate through a discounted payroll deduction or some other financial means. The goal is to educate participants about their current health status, knowing that a significant percent will address negative results by seeking care or changing a behavior.
Level 3 – Non-Incentive-Based Wellness Program: Once the biometric screening has been conducted, some employers provide a voluntary platform (usually an online resource) where participants can work to improve their health. These platforms typically provide exercise tracking programs, meal recipe ideas, etc. This type of program is there for the participants to use, but the employer does not provide incentives to the plan participants for usage.
Level 4 – Participant-Based Incentive Wellness Programs: These programs are similar to a Level 3 program, but also may include some health coaching. The main difference is that an employer will provide incentives for participation. These incentives are only tied to participation and would not require any measured improvement in health.
Level 5 – Outcome-Based Incentive Wellness Programs: The most aggressive form of employer-sponsored wellness program is an outcome-based incentive program. These programs are similar to the Level 4 program; however, the incentive is tied to the participants meeting certain measured health improvements.
Based on the cohort studies that have been conducted on the different types of wellness programs, we find that Level 1, 2 and 5 provide for the strongest impact to overall health plan costs. We also find that the administration expenses associated with sponsoring these programs exponentially increases as you increase in level. Therefore, the largest opportunity to impact the health of a population is to implement Levels 1, 2 and 5, but the greatest opportunity for ROI is to implement Levels 1 and 2.
This takes us back to the challenges of implementing a wellness program in a Tribal environment.
The goal is to implement a wellness program that provides the greatest opportunity for improved health of a population, while creating the largest possible return on investment. That is relatively simple, until you look at the different parties that a Tribal member interacts with to manage his or her health. For example, a Tribal member with diabetes who is employed by the casino may have access to a grant-funded diabetic program offered by the Tribe, clinical support through the Tribal clinic, a disease management program provided by the casino’s health plan administrator, lab work provided by the Tribal clinic, and biometric screening provided by the employer-sponsored health plan. All of these programs are trying to achieve the same goal, but there is certainly going to be some overlap and potential confusion. The trick is to make sure that these programs are talking to each other and being provided in the simplest, streamlined administrative way possible.
It sounds like implementing an employer-sponsored wellness program can be a bit of a gamble; however, trust me when I tell you that it is possible to coordinate these programs and achieve the goals of improving your population’s health and saving money on the health plan.
For more information on coordinating wellness plans, please contact Amy Hergenrother at [email protected].