healthcare

Why Employers Should Care About Their People’s Financial Stress

Let’s cut to the chase. Financial stress hurts your employees and that hurts your business. Dig into related loss of productivity, presenteeism, higher medical insurance claims, and suddenly the impact on your company’s bottom line gets very real.

So, what’s an employer to do? Is employee financial stress even your problem? Is your company’s profitability your problem? You’re tracking with me, aren’t you?

Financial stress isn’t a new concept. Employees around the globe have been struggling with this for years. In 2017, one study found that only 35 percent of employees in the U.S. expressed feeling satisfied with their current financial situation, which was a drop from 48 percent in 2014. That’s a double-digit drop in just 3 years. It’s not just young employees either. The number of bankruptcies filed by baby boomers has tripled since 1991. Strategic organizations are waking up to the need for financial wellness tools to maintain and improve employee health and work productivity.

Financial stress can have a serious impact on your employees’ health.

When money is keeping your employees up at night, it can take a major toll on their health. Financial stress has been linked to the following physical health conditions:

  • Migraines

  • Cardiovascular diseases

  • Insomnia

Another scary fact – a 2018 survey found that 8,000 Americans who suffered a “negative wealth shock,” defined as losing at least 75 percent of their wealth in two years, have a 50 percent increased risk of dying in the following two decades. The Great Recession not only resulted in employees losing their financial footing, it took a heavy toll on their physical and mental health.   

The more employees suffer from financial stress, so will work productivity.
When you’re experiencing money troubles, it’s difficult to think about much else. How many times have seen employees stepping into the hallway to take a call? How many have needed to leave work during their shift to pay basic utilities to keep their power on that day? A recent PwC study found that 43 percent of employees feel distracted by their finances to the point where they spend three hours or more at work thinking about or dealing with those issues. Along with distraction, financial stress leads to a rise in absenteeism. In fact, employees with the highest levels of debt are twice as likely to miss work

Fortunately, there are ways employers can address financial stress.
The first step is identifying how prevalent the problem is at your organization. Start looking for clues. Get your hands on your HR data. Are you getting feedback from your managers that they’re fielding an uptick in debt collector calls? Are you seeing a spike in wage garnishments? Has there been an increase in 401(k) loans and withdrawals?

If you’re seeing the symptoms, use your HR data to help employees find a cure. Begin taking a holistic approach to health and wellness by treating the whole employee. More employers are taking a complete look at their employees’ wellness in regard to their financial, mental and emotional health, rather than just focusing on their physical health. There are several reputable vendors in the financial wellness space. Look for a partner that is able to offer intuitive financial education for your employees. Consider adding a low cost loan option to your employee benefit program utilizing a socially responsible source such as Kashable to cover unexpected expenses.

Take a hard look at the healthcare benefits your organization offers. Do they ensure your organization is providing employees with access to quality care at low healthcare costs. The PwC study found that 22 percent of employees stated “lower healthcare costs” would help them achieve their future financial goals. It is imperative that we take the initiative to educate our employees how to gain maximum benefit from their healthcare benefits. Recently I had a conversation with an individual struggling under the high-deductible plan her employer had put in place to lower premiums. She had no idea that participating in the plan qualified her for an HSA. She was missing out on the triple tax benefit of an HSA while struggling with how to best utilize her new plan and not add to her financial burden.   

I know, lowering healthcare costs for employees sounds like an impossible task if you’ve been dealing with premium hikes, year after year. We’re seeing many mid-size employers opting for a modern health plan management approach to self-funded benefits to drive down cost while maintaining quality benefits. This includes things such as partnering with a people-friendly reference-based pricing vendor that reaches out directly to providers and negotiate fair-market reimbursement using Medicare as a reference-point. They prevent employers from paying inflated claims that are commonplace with traditional carrier plans. The people-friendly part is key. They differentiate themselves by providing employees with education and the support they need to help them deal with things like balance billing issues.

If you think you’re stressed out trying to lower your company’s benefit costs, imagine the stress your employees are feeling trying to live those benefits. As HR business leaders, we need to find the right balance for both the company and the employees. When more than one in five employees express a willingness to forgo future pay increases for better healthcare benefits, they’re sending us a message. We need to listen.

As innovative companies embrace the holistic approach to health and wellness, they’ll begin to provide benefits that address their employees’ financial wellness needs. In HR we want the win-win solutions. There are so many options to provide our employees significant relief in the financial wellness space. Why would we put it off any longer?

You can find more tips and resources on how to lower healthcare costs for your employees and your organization at GameChangerHR.com.

Breaking Down Barriers to Improve Health Outcomes

It’s no secret that U.S. healthcare spending is through the roof. We continue to hear alarming stats on how the U.S. currently spends twice as much on healthcare than ten other high-income countries. We continue to analyze why we’re not seeing better outcomes with all of the money being poured into the healthcare system. People blame these higher costs and undesirable outcomes to poor American diets, inefficient healthcare delivery systems, overpriced pharmaceuticals and unit costs. However, little attention seems to be given to things outside of the stereotypical healthcare experience, like limited access to healthy food options, lack of education, financial hardships or unsafe neighborhoods. These environmental, social and economic factors, also known as social determinants of health, can greatly impact an individual’s health, yet historically our healthcare system has not specifically focused on them.

Understanding the social determinants of health and why they matter.
Everyone deserves an opportunity to make choices that lead to good health. But in order for this to truly become a reality, advances are needed not only in healthcare delivery and technology but also in education, childcare, housing, community planning, business, transportation – just to name a few.

 According to Healthy People 2020, there are five key areas of social determinants of health:

  • Neighborhood & built environment – access to safe housing, parks and playgrounds

  • Health & healthcare – access to health coverage and quality care

  • Social & community context – support systems, discrimination and stress

  • Education – literacy, language, access to quality education and vocational training

  • Economic stability – employment, medical bills and income

These areas have the potential to greatly affect an individual’s health. In fact, social and environmental factors impact the risk of premature death by 20 percent, while genetics has a 30 percent impact. Health disparities also pose great financial risk and account for a whopping $102 billion in direct medical costs in the U.S. each year.

How to break down barriers to promote good health for all.
It’s clear that a traditional population health management (PHM) program simply won’t cut it anymore. Every person is unique and so is their health journey. An effective PHM strategy should be designed to be flexible enough to adjust care for someone who has limited access to public transportation, is unsure of their ability to afford healthy food options or is dealing with economic and family hardships. At Maestro Health™, we believe the entire PHM strategy must be redefined. That’s why our HEALTHY(me)™ program takes a holistic approach to address a person’s physical, financial and emotional wellbeing.

This holistic approach allows us to meet the person where they are on their healthcare journey and understand what “healthy” looks like to them. For some it may be hitting 10,000 steps on their Fitbit, while others would like to see a decrease in their A1C levels.

However, it must go beyond identifying personal health goals. We believe an effective PHM strategy must dig deeper to understand the barriers they are facing in their everyday lives that are preventing them from finding their healthy. For instance, if lack of public transportation has historically been a problem, then a personalized care plan should include something as simple as arranging a ride to a doctor’s visit.  

Take it one step further and apply technology to expand your data set. Utilize this robust data to derive additional insights to further identify and address an individual’s specific needs. According to PwC, 78 percent of providers stated that they are unable to identify their patients’ social needs due to a lack of data insight. Our HEALTHY(me) program provides nurse care coordinators access to a person’s personal and healthcare profile, in an effort to close gaps in care and assist providers in addressing their patient’s specific needs.

A PHM strategy that does not consider the social determinants of health, does not consider a person’s overall wellbeing. You can learn how we’re integrating this approach with our self-funded solution to help simplify experiences, improve health outcomes and reduce healthcare costs at GameChangerHR.com.  

3 Reasons I’m Excited to Be Here

By Florian Bezault, Chief Financial Officer

It’s official. I am a Maestronite. While I have spent most of my career with AXA working on everything from corporate finance to investor relations & risk management to healthcare operations, I’m beyond thrilled to begin this next chapter of my career as Chief Financial Officer at Maestro Health. Here’s why:

1. I share a passion to transform U.S. healthcare with my fellow Maestronites.
It’s no secret that the U.S. healthcare industry has reached its tipping point. The U.S. spends over $3 trillion on healthcare each year, yet Americans aren’t getting any healthier and the majority find it nearly impossible to navigate the complex healthcare landscape. That’s why I’m so proud to be working for a company with a mission to disrupt the industry by making employee health and benefits people-friendly again and to take consumer engagement to the next level.

2. It’s clear why CFOs love our approach to employee health and benefits.
I’ve been diving in and learning more about the solutions Maestro Health offers employers. The more I learned about our health plan management approach to self-funded benefits, the more I was convinced this is a no-brainer solution for any CFO in the U.S. While healthcare costs are at an all-time high (so much so that companies like Starbucks are paying more on healthcare than coffee beans) the (me)SELF-FUNDED BENEFITS™ solution has been saving our clients an average of 20 – 30 percent off their healthcare costs in the first year. For some companies, this could be millions of dollars in savings.

3. The culture at Maestro Health is one that cannot be beat.
At many companies, office culture is something that people like to talk about, but few truly walk the walk. I have quickly discovered that isn’t the case at Maestro Health. The values aren’t just painted on the walls at each office. The people in each office truly embody the values themselves. In the short time I’ve been working at Maestro Health, I’ve met people from all walks of life, that display the same level of teamwork, humility and bold thought while collaborating and working together.  

I am eagerly taking this next step in my career with Maestro Health. I’m excited to be a part of transforming the U.S. healthcare industry at such a critical time by solving the challenges experienced by far too many across the country.

Traditional vs. People-friendly reference-based pricing

By Ray West, Chief Growth Officer

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If you’re familiar with reference-based pricing (RBP), then you’re also likely aware that many early adopters did not have the best experience. They were promised RBP was a surefire strategy to prevent overpaying for medical claims. However, employers experienced an alarming amount of noise from their employees, who were struggling to cope with balance billing and fear of medical debt. Since then, some vendors have evolved the RBP game to include a people-friendly approach.

The traditional reference-based pricing model.
When RBP emerged approximately ten years ago, the model leveraged median prices in geographical locations as a reference-point for how much an employer would pay for provider services. RBP vendors then began holding strict reference points to Medicare for all service types. This created a “take it or leave it” message for providers, leaving them understandably frustrated.

This traditional model also left employees in the dark. As if the healthcare experience isn’t complex enough, employees were receiving bills from their providers for the balance their health plan was refusing to pay (aka, a balance bill). These bills came as a surprise to employees and vendors were providing little to no education or support to help guide employees on how to resolve these balance bills.

Eventually RBP vendors began to grow more flexible with their payment models by incorporating additional data to determine what was an appropriate amount to pay. Up-front and real-time member education became a part of their offering. Some even began offering employee assistance with balance bills.

The people-friendly reference-based pricing model.
Today, employers are able to implement a modern reference-based pricing model that eliminates over-paying for claims, but also offers complete transparency and the support employees need – the people-friendly reference-based pricing model. This new model improves the experience for everyone involved:

  • Providers receive fair-market reimbursement
  • Employers get connected with providers and see significant healthcare savings and transparent claims data
  • Employees get the support they need to navigate the complex healthcare system

People-friendly reference-based pricing still has Medicare at its core. However, it’s no longer a rigid, one-size-fits-all approach. Instead, these vendors directly reach out to providers and negotiate a fair-market reimbursement using Medicare as a reference-point. This ensures providers are being paid fairly for services and reduces the risk of employees receiving a balance bill.

It’s important to note that people-friendly reference-based pricing is not solely based around Medicare. These vendors offer employers a proactive provider disruption analysis, which helps identify the doctors an organization’s employees are used to seeing. This will often lead to provider outreach and contracting with providers to guarantee the provider will accept the negotiated pricing, essentially replacing traditional PPO networks with RBP networks.

The education and support offered by people-friendly reference-based pricing sets it far apart from the traditional reference-based pricing model. Vendors will navigate employees to high quality and low-cost providers in their area. One way they do this is by implementing copay incentives – offering lower copays for medical services if they visit pre-negotiated providers. In addition, employees are given education on how to react if they receive a balance bill. They’re also given the support and guidance necessary for handling a balance bill to eliminate the worry of medical debt.

Here’s a look at what the people-friendly RBP process can look like for an employee:

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If you’re working with an RBP vendor or thinking of implementing one, don’t settle for just any vendor. To determine if they’re truly people-friendly, ask them these simple questions:

  • How do they handle balance billing?
  • Will they be a co-fiduciary for the plan and provide legal services if needed during balance billing?
  • How do they support employees in learning how to navigate the healthcare system?
  • Are they flexible to your needs?

Learn more about how employers are changing the healthcare game by implementing innovative solutions to drive down their healthcare costs by visiting GameChangerHR.com.

Why Brokers Need to Manage Their Clients’ Healthcare Supply Chain

By Cory Friedman, Vice President, Benefits Consulting, GCG Financial

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As business leaders, our clients know that procurement of goods and services is at the heart of good business practice, and most manage their supply chain with diligence to ensure suppliers meet standards for quality and affordability. Yet, most employers don’t view healthcare services in the same light, and with healthcare as one of their highest costs, they really should be.

In fact, most employers have outsourced the design and management of healthcare services to a broker, consultant or health insurers that have little incentive to improve quality or affordability. In doing so, employers lose control and expose themselves (and their employees) to the wasteful business practices embedded in healthcare and provider contracts. Why are so many employers disconnected from managing one of the most important and costly expenditures for their organizations?

Employers have delegated accountability for healthcare services to human resources, seeing it as a “benefit” rather than a service to be procured in an effort to maintain the health, well-being and satisfaction of their workforce. The end result is predictable: immense and costly variations in access, quality and safety.

The response to the rising cost of healthcare is often reactive (and misguided), passing a portion of costs to employees or shifting the burden of purchasing healthcare services to them through high deductible heatlh plans or health savings accounts.

Employers are in the healthcare business, whether they like it or not.
According to the National Business Group on Health (NBGH), which represents 420 large employers on health policy issues, employers project the total cost of providing medical and pharmacy benefits to rise by 5% for the fifth consecutive year in 2018, bringing the total cost to $14,156 per employee. If an employer has 100 employees, that means they’re managing a $1.4 million healthcare business. At 1,000 employees, their healthcare business is valued at over $14,000,000.

So, what are you doing to manage your clients’ multi-million dollar healthcare businesses?
In today’s ever-evolving employee benefits landscape, we, as brokers and consultants, have an opportunity (maybe even an obligation), to change the game and see ourselves as healthcare supply chain managers willing to challenge our clients to think differently. We have to change our mindset and work to disrupt the status quo.

Successful brokers are not helping employers hold down cost increases by raising employee costs, deductibles, copayments and coinsurance. Instead, they’re applying supply chain methods to healthcare purchasing.

Starting with a self-funded health plan, which gives employers the advantage of examining their data, the best performing companies are building plan designs that work best for their company, identifying targets of opportunity and creating incentives for employees.

When you examine the data, you’ll find wide variations in charges by hospitals. Reimbursements by private insurers can be as much as ten times higher than Medicare reimbursements for hospitals within the same geographic area. To address this, employers are designing health plans and creating incentives designed to encourage employees to use more cost-effective providers. For example, start with high-cost elective surgeries that have a wide variation in price and quality among providers: total joint replacement, spine surgery, cardiac surgery and bariatric surgery, to name a few.

You can put the brakes on rising healthcare costs, without compromising access to quality healthcare for your clients’ employees, with help from the right partners. Partnering with a solution provider that offers an innovative and personalized health plan management approach is key to helping your clients fight skyrocketing premiums.  Ask yourself, “Are you skilled in defending the status quo, or leading performance improvement to give your clients the ability to compete and win?”

Recently I spoke on a webinar, where we took a deeper dive on how some brokers are advising their clients to drive down costs. Click here to download, “Change the game: How employers are winning against skyrocketing premiums.”

Cory provides guidance and objective analysis of group insurance benefits and is currently responsible for the health insurance and employee benefit programs of more than 200 privately held organizations across the country. In 2016, he was selected as a Young Gun Award recipient by Insurance Business America, which recognizes young professionals making a significant impact in the insurance industry. Cory was also named a “Rising Star” in 2017 and 2018 by Employee Benefit Adviser, earning recognition as one of 20 advisers nationally age 35 and younger who exhibit quick thinking, openness to change, and the ability to navigate the ever-changing employee benefit landscape.