Control and Reduce Healthcare Spending by Utilizing Wellness

The concept and practice of wellness as a corporate sponsored benefit in America is well known and understood, but not without question and debate.  Countless studies on program and plan efficacy, ROI, long-term impact, etc., have been performed, yielding mixed and conflicted results at best.  So, for every “pro” it seems you can find a “con”.  With that in mind, let’s examine some common sense factors that we do know.

1. No Mature Overarching Strategy

There is no mature, overarching strategy that prevails at the national level.  Some employers view wellness as a recruitment and retention element, while others see it as a compliance model to measure health status and associated costs. Yes, the ultimate goal of any employee wellness programs is to improve the health and wellbeing of participating members.  And, the executable steps in terms of program design and action have to be tailored to an individual population (no one cookie cutter approach will work for everyone).  However, there should be some agreement on how the program is designed and the results yielded; read that to be health-contingent outcomes based models.

2. Purpose and Usage of Data

As with the numerous variations of wellness program designs, the purpose, collection, and usage of associated performance data is equally as widely varied.  Take for example biometric testing.  First, there is a medium to high level of cost that employers invest in this valuable process.

Plan participants, then, go through the process and receive their results.  What happens next?  Is Purpose and Usage of Datathe collected data delivered at the individual level for educational purposes only; is it actionable in terms of insurance premium contribution costs; is it used for coaching engagement to mitigate risk factors; etc.?  Another aspect of ineffectively used data is the health care industry’s focus on claims, which are the byproduct of illness and disease.  Paying too much attention here will definitely take your eye off the ball and guarantee the generation of more, future claims due to poor health and lack of focus on health and wellness.

It’s a vicious cycle.  If your plan design doesn’t have a strategic vision on how, why, and when to take action on collected data, you will never receive results approximating a demonstrable ROI or improved health outcomes.

As a closing side note to this section, there is a whole list of things wellness vendors are doing with your members’ data that aren’t related to providing you a strong solution.  But, that is a topic for another blog…more to come here.

3. Accountability for Performance

The results, outcomes, and engagement in program participation ultimately falls on the plan participants themselves.  However, there is a greater level of accountability that normally goes unchallenged; and that resides with the brokers/consultants and vendor-partners who have been selected to drive your health and wellness programs.

As I mentioned before, each program has to be nuanced to your specific population’s needs in order to be effective.  Please understand that there are people in both these groups who are well educated on how to deliver a successful program—capable of doing a really good job.  And, yet, there are an equal number who aren’t.

Billions in venture capital dollars have flowed into this space over the last several years, giving rise to standalone-company-products that have really done nothing more than create fads and trends, which begin by showing great promise and pretty quickly turn into something analogous to a discarded child’s toy.

Health plans have developed similar offerings, but are only interested in using wellness as a loss leader to capture more share of the health insurance market.  By engaging in programs offered through the carriers, there does appear to be a conflict of interest because they make their money off members not being well.

How hard do you really think they’re going to work in order to reduce their revenues?  The confluence of stand-alone corporate health and wellness vendors and health plan carriers has only served to create a substantial amount of confusing noise that has failed to truly advance the concept and practice of corporate wellness programs. In short, following the “pretty shiny” object fails every time.

The vendors should be providing a proven solution, along with sound counsel, strategy development, and support.  The same can be said for broker/consultants who are recommending the vendors in the first place, based off really nothing more than who has spent the most on marketing and has the “prettiest” proposal and forged a “my favorite vendor” relationship with a few, key groups.  All broker/consultants will tell you they are vendor agnostic.  And, some are.  However, if you start analyzing their choice recommendations, some surprising patters will emerge that prove otherwise. Customers and members deserve better!

4. Market Mechanics

So, why do I assert that our country’s approach to wellness is upside down?  Simple—we have a delivery system that is highly contingent on disease-reaction.  Countless thousands of jobs are funded by illness and disease.  Wellness…well, that’s simply still a pipedream at this point because if it were properly researched, strategized, and tactically deployed would turn the health care industry on its head within a decade or two.  But, that is not to say that plan administrators don’t have the ability to drive and change the market; they do.

Deploying outcomes based designs with financial incentives/penalties, measuring year-over-year cohort results, and using that data to continuously refine a wellness program that works for your member population is truly a way out of this ineffective and costly cycle of just throwing money at a symptom (illness/disease) without truly addressing the root cause (lifestyle management choices that give rise to preventable health issues)—allocating the majority of your benefits dollars to the health carriers in hopes that your cost trends and member health statuses will somehow miraculously change.

You should push for best-in-class performance in terms of relationships, vendors, and guidance. Don’t be clouded or confused by a blizzard of data that supports the status quo.  If your trends are not proceeding in a successful and healthy direction, it’s time to have crucial conversations with those who are supposed to be supporting your company in achieving results.  After all, you’re paying too much money to settle for mediocrity.

Recommended Posts