Executive Perspectives Newsletter - FEBRUARY 2015

8/9/2019 Executive Perspectives Newsletter - FEBRUARY 2015

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One in Five InsuredAmericans Avoid Seeing aDoctor Due to Fear of Cost

Arecent online survey conducted by HarrisPoll on behalf of SCIO Health

Analytics® revealed that approximately twoin five insured Americans (38 percent) do

not have a good understanding of which healthcareservices are covered under their current plan. Onein five insured Americans, or approximately 44million people, have avoided visiting a doctor for ageneral health concern within the past 12 monthsbecause of cost concerns.

The online poll surveyed more than 2,000 U.S.adults aged 18-plus about their general sentimentsaround the Affordable Care Act (ACA) or Obamacare, healthcare costs and their overallunderstanding of the healthcare system, as well asservices covered under their health plan.

Ambiguity and cost fears prevent millions with achronic condition from visiting their doctor.

Approximately half of U.S. adults (117 million) haveat least one chronic condition, of which 14 percentof (or 16.4 million) have avoided a doctor’s visit inthe past 12 months because of cost concerns. Whilechronic conditions such as heart disease, asthma,and diabetes are generally incurable, they can bemanaged through early detection, improved lifestyleand treatment.

"These findings are particularly relevant at this timeas millions of Americans are once again decidingtheir annual healthcare benefit options throughOpen Enrollment," said Siva Namasivayam, CEO,

SCIO Health Analytics. "While Americans arespending more time researching health plans, thesurvey reveals a significant knowledge gap in thespecifics of their health care options that mayeventually lead to unnecessary risks and costs."

Namasivayam warned that the implications of thesefindings are even more staggering when youconsider treatment costs for Americans with chronicconditions are already around $277billion annually. Avoiding medical treatment forthese conditions can lead to an increased risk ofcomplications, emergency room visits,hospitalizations, readmissions, work absenteeismand disability that could potentially drive healthcarecosts even higher and cripple an alreadyover-burdened system.

When asked how their healthcare situation haschanged since the introduction of the AffordableCare Act:

• 41 percent of Americans say they have spentmore time researching what is covered byinsurance plans (either in their own plan or other plans).

• 60 percent of Americans say they do not have abetter understanding of the healthcare system

FEBRUARY 2015:

♦ One in Five Insured Americans Avoid Seeing aDoctor Due to Fear of Cost

♦ Onsite Clinics Are a Key Component to aSuccessful Health Benefits Strategy

♦ Employers Very Concerned About Health CareCosts – More Employees in Wellness Programs

This newsletter is for informational purposes only and should not be considered as legal advice.

Executive Perspectives

P.O. Box 8382-4 Main Street

Peterborough, NH 03458

Toll Free: 800-258-5318 Phone: 603-924-9449 Fax: 603-924-4490



despite the media coverage and public/politicaldiscourse around Obamacare.

• Among those insured, 44 percent did not knowthe out of pocket costs/co-pay for prescriptiondrugs, and 61 percent did not know the costs for urgent care/walk-in clinic visits.

The survey also found that age and gender play arole in understanding healthcare costs and services.

Among insured adults, 48 percent of those aged 18-34 say they do not have a good understanding of what healthcare services are covered under their plan, compared to 27 percent of those aged 65 andolder. Younger insurance holders, especially men,are also much more likely to be cost-consciouswhen visiting the doctor. When asked if theyavoided visiting the doctor for a general healthconcern in the past 12 months because of costconcerns, 40 percent of insured men aged 18-34said yes, whereas 27 percent of insured women inthe same age group responded the same(compared to an overall average of 20 percent for alladults age 18+).

While the ACA has encouraged the U.S. healthcaresystem to become more consumer-focused, thisstudy suggests that health plan managers need tobe more aware of the needs of the millions of

Americans who are new to health insurance andbetter communicate with more targeted messagesand education around plan coverage and cost.

"It’s like buying a car without a manual or taking atest drive. You are left somewhat disoriented in thedriver’s seat," said Dave Hom, Chief Solutions andBusiness Development Officer at SCIO Health

Analytics. "Health insurance companies need toadopt customized solutions based on big data tounderstand and reach these new members.Through the use of segmentation and consumer data such as medical literacy, communicationpreferences and geographic access to care,companies can find the most effective channels andmessages to educate members on coverage, costs,and how to get the care they need."

How do Americans want to receive health planinformation? According to the survey:

• 62 percent (the majority) say they would belikely to better understand their health planinformation using the websites offered by theirhealthcare plan provider.

• 41 percent would be likely to better understand

their health plan information using memberphone support offered by their healthcare planprovider.

• 37 percent of U.S. adults say they getinformation about healthcare costs and servicesfrom their insurance company.

• 31 percent get information about healthcarecosts and services from their doctor.

________________________________________

Onsite Clinics Are a Key

Component to a SuccessfulHealth Benefits Strategy

Employers are increasingly finding the useof onsite and near-site clinics as asuccessful strategy in controlling healthcare costs, enabling easy access to

medical services, improving employee health,enhancing engagement in worksite programs – andultimately increasing productivity, according to asurvey of 255 employers by the non-profit National

Association of Worksite Health Centers (NAWHC).NAWHC conducts an annual survey of employer sponsors of onsite clinics to enable them tobenchmark their operations and policies.

“Especially in light of health care reform, onsiteclinics are increasingly being recognized byemployers of all sizes as a valuable benefit toreduce costs and absenteeism, while serving as thehub to integrate all worksite programs, and increase

AWANE February 2015


“Younger insurance holders, especially men, are also much more likely to be

cost-conscious when visiting the doctor.”



employee health and satisfaction,” said LarryBoress, NAWHC executive director. “Onsite clinicsare not just for jumbo employers. We found anincreasing number of employers of all sizes arerunning these themselves or finding willing partnersamong local providers and vendors.”

According to NAWHC and other industry research,the greatest return for clinic value is amongemployers who experience high emergency roomuse for non-emergency conditions, show high levelsof lost time from unscheduled medical issues, or have covered populations that show low utilizationof existing primary care, preventive screenings or condition management programs and services.

Survey findings:

• A majority of respondents of all sizes said thefinancial objectives for their onsite clinics arebeing met, with 64% seeing a reduction inmedical care costs, almost 70% realizingreduced time lost by employees leaving workto see outside medical providers, and 63%had reduced use of the emergency room.

• Employers offering clinics are seeingenhanced integration of health managementservices, higher employee engagement inhealth management programs, and increasedeffectiveness of health promotion efforts.

• While most employers do not charge for clinicservices, many are unaware of the need tocharge employees with Health Savings

Accounts a fee reflective of market prices.• Over a third of employers with clinics do not

consider their onsite clinics as part of their benefits plan, and there is uncertainty in howto value a clinic for purposes of the ACAsexcise tax computations

• Telemedicine is an emerging trend for manyusing onsite clinics, especially in the areas of acute care, wellness and behavioral health.

• Acute care, emergency or first aid, preventiveand wellness are among the top servicesoffered at employer clinics.

• Over 30% of onsite clinics now provideprimary care services and this number isexpected to grow in the future.

• Nurse practitioners/RNs and physicianassistants are the main providers for theseclinics.

• Over 35% of employers self-manage their clinics and do not contract with a vendor or provider to operate the facility or hireproviders.

• While most employers contract with third-partyvendors to manage their clinics, an increasingnumber of employers are finding partnersamong local physician groups and hospitals.

• Lessons learned in developing clinics includedthe need to promote a clinics confidentialityand privacy; having providers who relate toand understand the workplace and its culture;offering services for free or lower than outsideservices; using vendors with state-of-the artROI tools; ensuring clinic activities areintegrated with all wellness programs andvendors; and offering easy access to clinic.

The survey included employers throughout theUnited States. Of the 255 respondents, 75% saidthey offered some form of worksite health programor providers are their locations, while 43% indicatedthat they have an onsite or near-site clinic. Amongthe responding employers, 8.34% said they had lessthan 500 employers, 11.67% indicated 501-5,000,27.5% 5,001-10,000, 20% 10,000-25,000, and15.83% had more than 25,000 employees.

AWANE February 2015


“Onsite clinics are not just for jumboemployers. We found an increasing number of employers of all sizes arerunning these themselves or finding

willing partners among local providersand vendors.”



Employers Very ConcernedAbout Health Care Costs –More Employees in WellnessPrograms

According to the latest Strategic Benefits –Health Care Survey report from the Societyfor Human Resource Management(SHRM), more than three-quarters (79

percent) of organizations that provide health carecoverage to their employees are very concernedabout controlling health care costs. The good newsis that wellness programs and flexible workarrangements are two of the most popular employeebenefits offered by organizations.

Costs Continue to ClimbOver the past three years, the percentage of companies indicating that their health care costswent up has remained about the same, yet high, at69 percent to 74 percent. To halt some of theincreasing costs, one-half of organizations indicatedthat they increased employee contributions to healthcare costs in 2014, while about one-quarter (26percent) of organizations said they planned toincrease employees share in 2015.

“A growing number of employers are askingemployees to contribute a larger percentage of their health care costs,” said Evren Esen, director of SHRMs survey programs. “But it is important thatemployers fully assess the potential impact of sucha change, especially in todays improved job market.Shifting health care costs to employees can lower employee job satisfaction and pose a barrier for attracting new talent.”

Almost one-fifth (19 percent) of organizations thatprovide health care coverage indicated that the useof consumer-directed health plans, such as healthreimbursement arrangements and health savings

accounts, was the most successful tactic for controlling health care costs. About one-half of respondents said they utilized health and wellnesseducational initiatives (56 percent) and lower-costgeneric prescription drugs (48 percent) to controlcosts.

Employees Respond to Wellness About three-quarters (76 percent) of organizations

offered some type of wellness program toemployees in 2014, an increase from 70 percent in2012. Also in 2014, about one-half (52 percent) of organizations provided employees with the option touse flexible work arrangements, such asteleworking.

“More and more employers are leveraging wellnessprograms and flexible work arrangements as part of the total rewards package that they offer employees,” said Evren Esen. “Offering wellnessprograms and flexible work arrangements can be aneffective way to recruit and retain talented employ-ees.”

Additionally, employee participation in theseprograms is increasing. However, employeeparticipation in flexible work arrangements isprogressing at a slower rate than wellness

programs. More than one-half (53 percent) of organizations indicated employee participation inwellness programs increased last year, whereas justunder one-third (31 percent) reported increasedemployee participation in flexible workarrangements.

“It is important to understand the obstacles that maybe impacting employee participation rates in flexiblework arrangements,” said Esen. “There needs to besupport from management and leadership in orderfor more employees to participate in flexible work

arrangements.”

The survey also looked at the effectiveness ofwellness programs.

• Health Care Costs: Seventy-two percent oforganizations found that wellness programswere somewhat or very effective in reducinghealth care costs in 2014.

• Employee Health: Seventy-eight percent oforganizations rated their wellness programs asbeing somewhat or very effective in improvingthe physical health of employees.

• Wellness Incentives: About two-thirds (67percent) of organizations offered wellnessincentives or rewards for participating inwellness programs. Eighty-five percent oforganizations indicated that wellness incentiveswere somewhat or very effective in increasingemployee participation in wellness programs.

AWANE February 2015


Executive Perspectives Newsletter - FEBRUARY 2015

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