By Maria K Todd, MHA PhD
CEO & Founder
Mercury Healthcare International
At EBA’s Workplace Benefits Summit Wednesday in Nashville, Tenn., Winston Ball, chief operating officer for hubbub health said, "“To find ROI [on wellness] can be very difficult today. You may need 1-3 years of claims data. You need to be able to compare claims data from year to year and compare claims data that has not served wellness either.”
He's right. Every day when we work on new corporate medical travel administration program development for self-funded employers, we find ourselves poring through past claims data, predictive modeling reports and plan beneficiary assessments to determine "if" and "why" someone employed by the company or recently retired would want to enroll into a comprehensive medical travel program for executive checkups, or surgery and medical care away from home and how our client can hone in latch onto that reason.
We don't approach any client with a one size fits all approach or even the assumption that a medical travel program is right for a particular group. Not without the data to back up the assumption and model predicted outcomes.
What's Missing from the Wellness Success Strategy
1) Visible leadership by company executives, middle management and at the water cooler gossip level.
2) A clear message from the company that a culture of wellness and optimal health is important to bottom line performance, raises, productivity, absenteeism, presenteeism and work injury prevention.
Michelin North America executive Barry Cross announced in September 2016 that the tire company intended to recruit a chief medical officer to keep its employees “as healthy as genetically possible.” That's not something we see often enough. Most employers that call us to investigate the potential of a medical travel program can't even access their past claims data from their TPA. When we ask why not, they tell us that the TPA won't release it for review - not by them, not by anyone.
In this day and age, for a self-funded health benefit plan to accept a "no" answer to that request, is just plain ludicrous. It is grounds for termination of the contract with the TPA or ASO... but only if your Service Agreement contract with them enabled you to request and receive the data in the first place. Many plan administrators and benefits managers overlooked that little detail in their Service Agreement with the TPA or ASO or PPO. Then when they need it to analyze their own claims data or have it analyzed by us - they meet with fierce resistance.
Why? Because perhaps the TPA, ASO or PPO knows that it isn't doing its level best to bend the cost curve - but doesn't want to make it easy for the employer to examine and determine that there's room for improvement. I have faced this resistance for the past 20 years when working with client employers, unions and associations on corporate medical travel administration and plan design.
Plan Administrators have a fiduciary duty to ensure to ensure that patients receive quality care, at the right time, in the most appropriate setting and to save trust fund or corporate funds earmarked for the health benefit program. If they cannot access the data, how can they be compliant? Surgeries account for 30% of total medical spend, according to our analysis of many employer accounts. Sometimes, the dollars aren't different, but the quality and clinical outcomes are better if the care is sourced at the same price a few counties over, or a few states away or across the country.
The decision Michelin Tire has made to create a sustainable culture of health that yields long-term positive return on investment is only the beginning of a 10-15 year transformation of the company's approach to benefits, compensation and retirement for its 22,000 North American employees. To this, they have also added 4 worksite health centers. Michelin spends about $250 million a year on total healthcare, which includes four family health centers with annual operating budgets of $5 million. If they can save $1 over the operating costs and sunk costs for startup of those for worksite health centers, they are in the black. These four centers aren't the typical grungy public health clinics either. The Michelin Family Health Centers, located in Greenville, South Carolina, Lexington, Kentucky, and Ardmore, Oklahoma, offer 30-minute appointments to employees. Michelin describes the centers as “concierge medicine,” which is becoming a growing trend in the benefits package for employers.
For the past 13 years, Mercury Healthcare International has advocated for this integrated approach: worksite health centers, concierge level care that drives patient engagement, prudent local health services procurement complemented by a corporate medical travel program where it makes sense to do so. We've developed a few worksite health centers, evaluate several others that were not feasible for one reason or another, about 430 concierge medical practices in the USA and abroad, and we built the first and only globally integrated health delivery system® for corporate medical travel services in the world. This concept by Michelin proves that American employers are interested. Michelin has moved the needle on ROI in a positive direction. Through the centers, along with gym reimbursements, free medication for condition management and on-site gyms, Michelin reduced metabolic syndrome by 12% in three years. They plan to add telehealth for reinforcement.
Bending the cost curve
Despite spending $250 million a year, Michelin, like many other large companies, is struggling with rising healthcare costs. Cross said his company is seeing $32 to $40 million in medical increases annually, a trend that most employers are finding to be unmanageable. For Michelin to see a benefit through medical travel that would reduce costs by $10 million a year, it needs to have 667 cases with an average savings of at least $15,000 per case across its 22,000 North American lives. Can it be done? It depends on what the past claims spend data indicates.
Individual digital health engagement - Patient Generated Health Data (PGHD)
Yup, its a new acronym!
Patient-generated health data (PGHD) is health related data created, recorded, or gathered by or from patients (or family members or their caregivers) to help address a health concern. PGHD include health and treatment history, biometric data, symptoms, participation in wellness activities and lifestyle choices. Some is recorded by a device and some is language-based information supplied by the employee or plan beneficiary. PGHD combined with mobile remote monitoring can also be used in the medical travel setting to reduce complications and readmissions, and measure health status between the care discharge at the destination and the continuity of care back home - especially where complex chronic conditions such as CHF, COPD, NIDDM, reactions to new medication regimens, and hypertension are involved.
The Pew Research Center maintains a website where their research related to health and healthcare is posted. The Health Fact Sheet found there includes the following information:
- 60% of U.S. adults say they track their weight, diet, or exercise routine
- 33% of U.S. adults track health indicators or symptoms, like blood pressure, blood sugar, headaches, or sleep patterns
- 12% of U.S. adults track a health indicator on behalf of someone they care for
Health Risk Assessments Coupled with Executive Checkups as Medical Travel Incentives
A health risk assessment is a questionnaire, usually brief, that is used to capture information about health risks. A HRA may be provided online by a health plan or a healthcare information or wellness site. They are actually better when conducted in person, in front of a qualified health practitioner as part of a comprehensive executive checkup - done all in a day, at a pleasant destination and perhaps coupled with a team building exercise, a training conference, or a bleisure vacation.
A HRA includes lifestyle data and sometimes quality of life data. Typical questions pertain to smoking, alcohol and drug use, UV exposure, diet, exercise, and seat belt use. Poor behaviors related to these items increase risk for illness and premature death and higher health costs. A HRA will usually include the date of last checkup, Blood Pressure, Total Cholesterol Level, High Density Lipoprotein (HDL), LDL cholesterol, date of last vaccinations and date of latest cancer screenings. Coupled with a mandatory executive checkup for corporate executives, companies can avoid major health surprises, intervene sooner to mitigate acuity and chronic disease, or start succession planning if they find a serious condition was overlooked and is now at the late stage of irreparable health harm. The information gleaned from HRAs can result in improvements in quality, care coordination, patient satisfaction, patient safety, rapid intervention and cost savings.
Companies that are able to invest and transform healthcare will be better equipped to control rising costs
At Mercury Health Travel, we discovered that most companies are unable to efficiently manage employee benefits programs in the face of rising healthcare costs because they lack effective tools. They continue to do the same things over and over and over again, resulting in higher costs, reduced employee health, and lower productivity. Perhaps a different approach is in order?
As I said before, many companies "wing it" without data that they should have access to from their ASO, TPA or PPO plans. Others rely on outdated third-party reports, siloed systems, and manual processes to make decisions and administer programs. Many companies require plan beneficiaries to navigate through complex health plan websites instead of a straightforward, role-based internet that only shows them relevant information about their personal eligibility, benefits and coverage. Without required data, no company is going to invest in any medical travel program analysis or feasibility study. If they cannot measure their healthcare costs and baseline performance, they cannot quantify results and categorize them as worth continuing or abandoning the program in favor of trying something else. That "something else" and "bright shiny object" syndrome has most benefits managers fatigued.
The new Higowell medical travel program we helped to design with our partners in Ireland and Germany is not limited to medical travel benefits management. It can serve as a full scale, health benefits platform can enable decision-makers and employees alike, creating opportunities to increase wellness and employee retention while reducing costs and coordinating care across an integrated health delivery system like the one developed by Mercury Healthcare International. What's exciting is how little the Higowell system costs. An employer can have the system up and running, tested and in service for less than $100,000.
About 30% of employers we've interviewed have no plan to tackle rising healthcare costs
To fail to plan is to plan to fail. The remaining companies we've spoken with either plan to transfer more cost share to the beneficiaries or cut benefits. These two flawed strategies will hit them in other ways: risking negative outcomes in employee health and wellness and the ability for companies to attract new talent. Rising healthcare costs also drain company resources and their ability to invest and pay better salaries. This, in turn, reduces the ability to be a competitive employer and attract the best talent. As employees get "bummed out" about benefits, even if the work is stimulating and personally gratifying, they begin shopping and updating their LinkedIn profiles to be more attractive to recruiters. When they leave, they take company secrets, methods, company paid training, new skills and best practices and carry them to competitor organizations.
A system like Higowell, enables both continuity of care and case management for a nurse and a corporate medical director, like the one Michelin will hire, to make decisions, manage programs or investments, create wellness campaigns or administer benefit programs in real time. Over 70% of employers we've spoken with currently rely on data supplied by their TPA, ASO or PPO without any benefit of verification and audit because the raw data is not available to them, even when they ask. These are often sent out quarterly, and it is then too late and too difficult to remember what was done that caused the costs. Fewer than 5% of employers we've spoken with receive reports more frequently than once each month. They cannot react to short term trends in spending on healthcare.
"Fewer than 5% of employers we've spoken with receive reports more frequently than once each month."
Employers also find it impossible to properly manage demand for mental health services, because HR and the EAP provider aren't aware of the health impact stemming from lack of timely access to care for their employees until months later. If they were made aware of this trend in real time, they could steer employees toward available benefit programs and cost effective treatment - in person or through telehealth. The lack of these inputs hinders advancement and improvement in managing healthcare within self-insured companies.
About one-out-of-five employers are currently able to use internal analytics tools to manage benefits programs and investments in this way. Again, much of this constraint stems from lack of access to data because someone else with a self-serving contract is in a position to restrict access to it and prevent the employers from making good benefits decisions that are unique and innovative for their company.
Fiefdoms of the Health Data Warehouse
The hired data custodians have negotiated contractual restrictions and deals to protect their fiefdom in a bizarre conflict of interest that maintains the TPA, ASO or PPO's status quo and protects them from having to keep up with innovation or risk losing the account. Without data that is timely, the employer cannot call out the TPA, ASO or PPO and say, "I want something different." or "Let me see what's happening with such and such utilization." That's especially true if the employer isn't getting data until it is months old, and then cannot challenge the data because all they get is a pretty report, and not source citations and statistics and trend reports in a timely manner.
Going forward - what's next?
At Mercury Health Travel, we believe that we can help employers work around the data access and decision-making process. First, we don't want to hoard their data and reports. We want to review them with them every month to check in and see how we can save them money and raise quality. First, by integrating data sources across silos, bringing reports in-house, and using analytics tools, our clients will gain the real-time insights required to manage their programs effectively whether their program is across the nation, across the county or across the ocean. We want to help them examine and identify healthcare costs and quality problems before they occur and evaluate the levels of plan beneficiary engagement and success of programs - including a medical travel program, if warranted, on an ongoing basis. We pledge to help them improve decision-making capabilities starting with an examination of current business processes, technology, and skills to leverage the wealth of data available.
We talk with employees to see if they are in for a medical travel option. We make sure that any program we design for an employer, labor union or association is going to take into consideration employees’ individual needs and provides them with contextual, relevant information - not scare them by allowing them to think that they will soon be forced to get their healthcare in some distant developing country where the message is a bird song - "cheap cheap". We don't just say "here's your new portal software". We have the ability to test the user experience before we install it on a beta pilot program with only one or two conditions, surgeries or focus areas.
We don't offer a one size fits all medical travel program. Each one is custom designed for the client and its workforce, and costs far less than most employers imagine and can integrate biomarkers, telehealth, worksite health centers, and medical travel to augment the employers current leased network arrangement from a local or national TPA, PPO or ASO. The days of doing the same thing over and over and over again and just paying more are over.