My previous blog tried to expose the aspects of Health Insurance and Healthcare in the Indian context. The following blog tries to address matters on preventing the huge increase in health insurance premiums which is every organization's concern area during annual insurance renewals.
Haven't we all heard the old adage "Prevention is better than cure"? It can't be truer in the case of Health Management Initiatives at organizational levels. There are new benefit systems that is being designed that include flexible, hybrid designs that take a holistic view of employee health.
When we are all healthy and keep fit, the chances of falling sick and using the insurance benefits come down leading to lower claims. This in turn will help all of us in controlling the increase in insurance costs.
A step in this direction is a 'World of Wellness' initiative of PeopleHealth. Programs under this will be customized and implemented based on the diverse needs of employees. The main objective is reduce health risks of employees and thereby bring down the claim on lifestyle diseases.
Walking uphill together
PeopleHealth today is working towards incorporating Healthy lifestyle and wellness programs into benefit structures of organizations. However the stakeholders- Organizations, Insurance Providers and wellness Custodians will have to jointly assume greater responsibility for the success of such initiatives.
What should the organization do?
- Educate the employees of the organization in using the health insurance appropriately
- Knowledge of insurance benefits is very important. Always do a thorough study before using the insurance benefits.
- If its an emergency seek the support of your TPA in utilizing the benefits
- If it's a non-emergency
- Check if your requirement is a common procedure(E.g.: Maternity ,Bye Pass surgery, Cataract, Knee replacement etc)
- If it is a common procedure enquire if the rates quoted is the same across similar facilities
- Also check if the hospital has differential rates for insured and the non-insured.
- If the rates for the non-insured is lower, you might opt to use that facility and claim your insurance later from your TPA
- Knowledge of insurance benefits is very important. Always do a thorough study before using the insurance benefits.
Excerpts from a PWC study
Eighty percent of companies surveyed said employers could help reduce costs by providing employees with more information about healthcare prices and quality. Most employers were confident of their employees' ability to make good decisions if given accurate and easily accessible information. Close to seven out of 10 employers believed that if they provided better information to evaluate drugs, doctors and hospitals, their employees would have lower healthcare costs and higher quality care. However, only 38% of employers indicated that they provide "a great deal" of information, updated regularly, to their employees for this purpose, while 42% said they provide a "moderate" amount.
When survey respondents were asked which actions, if taken, would reduce their company's healthcare costs, most agreed that the following three actions would do so:
- • Make employees pay a higher percentage of healthcare costs
- • Give employees more information about healthcare prices and quality
- • Provide financial incentives for employees participating in healthy lifestyle programs
What will PeopleHealth do?
- Strategies: We will set a course that aligns health care strategies with people and business strategies. We will open up channels for collaboration that can increase information sharing and the development of new solutions.
- Flexibility: We will design benefit plans and programs and develop targeted programs that address the specific needs of the team members to most effectively improve the health as well as increase the opportunity for cost savings.
- Think prevention: We will develop a cost-sharing mechanism that promotes access to preventive services and take steps to integrate preventive services and insurance management.
- Revisit wellness: New initiatives to encourage healthy lifestyles and wellness will be considered as part of the benefit plan design to reduce healthcare expenditures
These programs may need to include incentives for participation, in order to encourage employees to lead healthier lifestyles. This initiative provides an opportunity for innovation to collaborate with employees to design new wellness and prevention programs, fostering employee involvement in their own health.
- Value transparency: We can source and develop information on the costs of common procedures and the appropriate way of utilising it.
- Provide education: PeopleHealth will develop and deliver training and education to enable employees to be better consumers–to fully understand the benefits and understand the real cost of healthcare and its effect on their personal budget and the organization's bottom line.
Deploy an education process that is continuous and engages employees in an interesting and convenient manner. In order to maintain a successful program, employees need to be reminded frequently what programs are available, how they can participate, and the rewards available for that participation. Executing these changes will require changes across the spectrum requiring leadership and changing roles and activities of each of the stakeholders
In Conclusion, there are many opportunities for us to take proactive steps in managing healthcare costs and enhancing the quality of the benefits that are available. We will take a more holistic look at the problem. The change to proactive healthcare is neither simple nor quick, but if executed well, may drive long-term benefits to all of us alike.
Reference:
- Healthcast 2020:Creating a sustainable future-A study by PRICEWATERHOUSECOOPERS
- www.irdaindia.org
- www.ibef.org
- PricewaterhouseCoopers' Health Research Institute
- First Consulting Group
- McKinsey studies on Healthcare
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