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Health Care
Headaches
Pain relief can be as close as a
computer for employees
who experts say should learn more about their benefits
By Lawrence Bivins
An
adequate health plan remains high atop the list of benefits that
workers expect from their employers, second only to paid vacation
time. But health insurance premiums also constitute the most expensive
employee benefit. And those costs continued rising an average 10 to 13
percent this year.
Adding to the complexity is the mind-numbing detail and frequently
arcane language used by insurers, human resource professionals and
health care providers to describe benefits. But there are a number of
steps companies can take to be sure they’re getting the biggest bang
for their health plan buck.
The most important step is for business owners and their employees to
invest more of their time in learning about coverage and costs. They
are, after all, the ones who pay.
“Employees are paying more and more,” says Paul Mahoney, executive
director of the North Carolina Association of Health Plans. Whether
they realize or not, employees already are footing the bill one way or
other, Mahoney adds, especially as increasing health plan costs nibble
away at company profits to a point where year-end bonuses dwindle or
expansion plans are scrapped. In fact, skyrocketing employee benefit
costs are among the competitive pressures driving many manufacturers
— and their jobs — offshore.
Whose responsibility is it to help employees better understand the
intricacies of their company-sponsored health plans?
Most experts believe employers and the health plans they choose bear
the greatest responsibility for making sure employees understand their
benefits. But the most effective solution requires the proactive
involvement of workers in this learning process.
“Plans can certainly do a better job educating consumers,” says
Steve Graybill, a senior health care consultant at William M. Mercer
in Charlotte. “But ownership of the problem,” Graybill emphasizes,
“really comes back to the consumer.”
Ask More Questions
In order to fully understand their health plans, Graybill says,
employees must begin to ask more of the right questions. “It’s all
about consumer empowerment. Managed care has maximized the power of
networks about as far as it can. Maximizing consumer empowerment is
likely the next wave.”
Most consumers are accustomed to asking two questions: “Who are my
doctors and how much does it cost me to see them?” Graybill suggests
they follow up with another series of questions, such as, “How will
the plan help me manage my illnesses? How will it work with me and my
provider in managing illnesses? And where can I go to find additional
information?”
To get answers to these questions, consumers now have a valuable
resource in the form of Internet- and Intranet-based tools, both of
which can offer a world of information for plan members seeking
answers to their benefit plan questions. A number of large companies
have begun developing easy-to-use employee “portals” as part of
their overall human resource programs.
Their hope is that such tools will demystify healthcare for a critical
mass of their workers, who would then be able to make better decisions
about their care. For example, Ford Motor Co. was so eager to see
workers use the Internet to learn more about their benefits that the
automaker began offering employees deep discounts on personal
computers.
Such systems clearly have rewards, not the least of which is saving
cash that would otherwise be spent on printing, distribution and
clerical support. There also are well-documented savings in
productivity. After Lucent Technologies moved its benefits to an
online portal, for example, employees reported completing their
enrollment procedures in five minutes or less.
But in the case of Lucent, the objective went further than mere
administrative savings. “Our goal is to change the underlying
problem of passive, price-sensitive health-care consumers by putting
people in charge of their own care,” says Pam Krol, director of
health and welfare benefits administration at Lucent. The company’s
approach mixes co-insurance, deductibles and other risk-sharing
mechanisms with targeted, condition-specific information and education
to build a more “choice-driven” health care model.
Mercer’s Graybill likes the online approach, but insists the problem
continues to rest with workers not being proactive about using the new
tools. In fact, a nationwide poll by Cyber Dialogue, a New York
marketing firm, found that while 78 percent of Americans preferred the
option of managing their health plan benefits online, only 8 percent
of insured Internet users visit their plans’ web sites. In fact, 68
percent said they were unaware their plan even had a web site.
Using Your Broker
Sophisticated web portals may be a viable option for the companies
with thousands of employees, but what about smaller firms squeezed by
skyrocketing health plan costs?
For their employees, getting the right answers to the right questions
may lie less with high technology than with the time-tested personal
touch of a qualified insurance broker.
“The employer’s job is to make a product and to make a profit, not
become an expert in the insurance business,” says Steve Zaytoun,
owner of Zaytoun & Associates, a Cary insurance brokerage
specializing in health coverage for groups of 100 or less. While small
business owners may lack the time to become intimate with every aspect
of their health plan, Zaytoun says a good understanding of plan
benefits by employers and their workers nonetheless remains key to
getting full value from a plan.
Zaytoun’s approach is one of high-touch: he and plan representatives
regularly brief employees about coverage during face-to-face
enrollment meetings. “I view it as part of my job working for the
client,” he says. Meetings typically last from 30 minutes to an
hour, and it is not uncommon for Zaytoun to visit a client late at
night or early in the morning to explain new plans to the second and
third shifts.
Employers, he says, must always struggle with apathy on the part of
many people about the details of their coverage. There is little
urgency to understand plan benefits — until the day arrives when the
worker needs them. “No one wants to sit down for the evening and
read up on their health plan when they’re well,” Zaytoun says.
Covered in his enrollment briefings are topics such as costs,
benefits, enrollment forms, searching for providers and handling
claims.
Zaytoun and others encourage plan enrollees to ask questions during
the presentation, noting that it is a natural reaction for some to
feel intimidated by a plan’s language and details.
“I thought the translation was very easy,” recalls Anna Jackson,
an administrative assistant at a Fonville Morisey Realty office in
Cary. Her firm switched plans earlier this year, while she was
expecting her first child. Jackson admits that her pregnancy
necessitated getting a firm grasp on her new coverage, although the
enrollment briefing she was given by plan representatives quickly
addressed her concerns in easy-to-understand language. She was
particularly curious about whether she would have to change physicians
and whether the dental benefits available under Fonville’s new plan
were more generous than those she was eligible for under her
husband’s employer-sponsored plan. “They came in and went over the
benefits forwards, backwards and upside-down,” she says.
Experts say questions about Ob-Gyn coverage and family planning
services are good ones to ask during enrollment. Others they recommend
bringing up:
u Are mental health services provided?
u How about coverage for pre-existing conditions and disabilities?
u Are physical therapy and other rehabilitative benefits included?
u What home health, nursing home or hospice care services are offered?
u And is there coverage for alternative health, such as acupuncture,
or experimental treatments?
Some plans offer members health education and preventive care, but
services differ. Members should ask questions such as: What preventive
care is offered, such as shots for children? What health screenings
are given, such as breast exams and Pap smears for women? Does the
plan help people who want to quit smoking?
HR’s Vital Role
There are few offices inside a company as important as human
resources. It is usually the first point of contact for workers
seeking information about health coverage, and it is a key player when
it comes to maximizing the value of a health plan. From the
company’s CEO to its line workers, no one is likely to understand
benefits if those in the HR office are themselves unsure.
Zaytoun, whose client list includes Fonville Morisey, suggests that
adequate planning on the front end can reduce many headaches in the HR
office down the road. “It’s better for us to take the time upfront
rather than have people stream into the HR office later on,” he
says.
That is especially true when a group is switching to a new plan with
different features. HR officials, like employees, have a point of
reference with the old plan. In most cases, representatives of the new
plan lack that perspective. “In our case, there were two
representatives from the plan and two of our own human resources staff
who helped explain benefits during the enrollment meeting,” says
Fonville Morisey’s Jackson. Working as a team, she says, the
briefing left little room for confusion.
For those businesses that are too small to even staff an HR operation,
it is vital that owners and at least one key manager understand the
plan and its coverage — or can easily obtain answers to questions
that commonly arise.
Use Your Plan’s Web Site
Even though most firms are unable to offer their own online benefit
systems, plan administrators, business owners and employees can
benefit from web sites developed by the plans themselves. “Most
plans now have web sites that can be very helpful,” Zaytoun says.
At Blue Cross and Blue Shield of North Carolina (BCBS-NC), the
state’s largest health insurer, a simple-to-navigate web site (www.bcbsnc.com)
offers several search engines that help plan members locate
participating physicians and other providers. Users can drill down to
local providers that best fit their needs and preferences — a female
dermatologist or a Spanish-speaking ophthalmologist, for example.
Education is also a large component of the site, with links to a
confidential information center available anytime a member has
health-related questions. Users can order free wellness materials,
send questions via e-mail to a registered nurse, or access a
well-catalogued library of recent newspaper and magazine articles on
various health topics.
Finding Other Extras
As part of their drive to bring greater value to their clients and
customers, insurers are adding new discount programs and other
features that don’t tack on new costs to the plan. Because there
isn’t an aggressive campaign to get the word out, many are unaware
that they have access to such benefits.
Blue Cross Blue Shield’s alternative treatment package, known as Alt
Med Blue, is a discount program arranged by the company with an array
of alternative providers. Included are message therapists,
acupuncturists and nutrition counselors. Discounts of as much as 25
percent are offered on such services, as well as participating classes
in yoga, tai-chi and more. Alternative providers can be located
through a search engine on the BCBS-NC web site or via a toll-free
telephone number. Other insurers around the state have begun offering
similar programs.
“People want choices in their daily health care,” says Michelle
Vanstory, a spokesperson for BCBS-NC in Durham, pointing to research
showing that 40 percent of Americans have tried one or more
alternative therapies during the past year. “We get a lot of
positive feedback from employees about the program. Message therapy is
by far the most popular service.”
And it’s a program employers like, she says. Certain benefits, such
as stress reduction, can help workers become more productive. Better
still, she explains, since it’s a discount program, there are no
claim forms to file and no additional costs to the employer.
Fonville Morisey’s Jackson has heard about the discount program that
she can access through Blue Cross, her group plan, but admits she has
yet to take the time to explore using it. “I think it’s terrific
that we have access to those types of benefits.”
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