Maximizing Benefit Value

“It’s holistic,” says Sue Eskedahl, vice president of Employers Association, Inc., a human resources management consultancy with offices in Plymouth and St. Paul. “You look at the total package of benefits that you are offering to your employees, and you evaluate the value to the company and the value to the employee of having access to those benefits. Some employers are engaging in benefit opinion [surveys] with their employees to find out what is important to them and what has value to them. You are weighing employee needs against employer capabilities, with the hope of bringing an overall healthier lifestyle to the employees.”

“What we’ve done on value-based benefits is to develop plans that meet the needs of the demographics,” says Thomas Miller, CEO of Financial Concepts, an employee benefits consulting firm in Plymouth. ”Let’s say we have a larger-than-average population with diabetes, or whatever. We might be giving low-cost services for diabetes so they can keep that under control.”

That’s a concept that’s spreading. Burrows says some of the employers in Blue Cross Blue Shield’s fold have begun to consider providing low-cost or no-cost insulin and syringes to diabetic patients. “Anything that would remove the barrier to that person being compliant to their treatment plan is potentially worthwhile, because it means they can have the best health available,” he says. “If a diabetic has a barrier as small as $50 worth of insulin and syringes to good health, why ignore that? Why not just push through that barrier and see if we can’t knock off at least one office visit?”

As these types of benefits become more common, they may begin to dovetail with wellness programs. Van Dellen says these programs are not a prerequisite for broad-based value-based plan designs, but they’re very much in the spirit of the movement.

“What we like to do here is go beyond the drug definition of value-based benefit design,” Pare says. “Right now we are working on a project with diabetes, [and one of the] measures of optimal care for patients is smoking cessation. That necessitates that we go back and look at our plan designs and see whether or not we cover smoking cessation programs.”

In general, preventive care is critical to the success of a value-based model. As Martin notes, any plan that puts a high copay on doctor visits will tend to fall down when it comes to disease prevention. And one of the reasons wellness programs are increasing so markedly in popularity is that they have been shown to save everybody money in the long run.

“Most of the studies suggest that between 25 and 50 percent of claims are created by modifiable behaviors,” Martin says. “After conducting health risk assessments, a lot of employers are starting to provide advocates and coaches to assist people in their nutrition or body weight needs, their stress issues, their physical fitness, their smoking issues.”