The basic tenant of most “wellness” programs is to make people healthier and reduce costs by creating a more healthy group. While it is difficult to argue with this seemingly obvious statement, to achieve a more healthy group who then produce lower costs is a complicated undertaking and one that is difficult to prove without using measures of savings outside the medical benefit program such as decreased rates of absence, fewer sick days, decreased W/C claims and improvements in productivity. If we assume these non-medical benefit items are, in fact, savings, it may or may not be directly related to any wellness programs in place. Companies that are willing to invest in wellness might also so things to improve the work place in general, add safety programs, provide additional employee benefits, allow more liberal use of unused sick days, etc. These decreases may coincide with wellness programs but not be caused by them.
The BAS ACTA Care program (and others like it) revolves around several parts including biometric evaluation, health risk assessments, predictive modeling, health advocacy, on-site coaching, utilization review, case and disease management and on-site health clinics. All combined, these can total many tens of thousands of dollars for modest size groups and hundreds of thousands for medium size groups, taken to the ultimate. On-site screenings alone cost about $200 per patient on top of the cost of ACTA Care as this is an outside contracted expense and not included in any “basic” fees.
Evidence shows that the most likely outcome of biometric evaluations, health assessments or screenings is higher not lower costs. The discovery of high blood pressure, cholesterol or blood sugar will, obviously, lead to treatments. While no one would argue that finding these things out is a good and noble action for an employer to take, the reward will be higher costs generated from increased physician visits, treatments and ongoing maintenance medications. In dollars and cents, the question becomes how many of these patients uncovered are with the employer long enough that the cost of discovery and treatment is less than the complications avoided. How do we even measure complications that did not occur…how do we know they would have??? We can go broke doing all the things we can find that will save money in the long run.
In reality, this is not advocating against this new BAS approach. However, it is important to recognize what it is and what can be reasonably expected as a result. Considering the manner in which reinsurance is structured, no one person can generate more than a fraction of total plan costs. With most groups this is about 5% or so. If a major cost were to be avoided, that is the max savings. You cannot save more than the specific exposure with any single “prevention”.
On the other hand, the cumulative cost of medical spending on prescription medications and medical claims of non-major status are 20 to 50 times the amount of a single spec hit. ACTA Care does little or nothing to control what services are provided for what conditions and continue to allow any test to be run for any reason deemed “appropriate” by the hospital and physician. In fact, it will increase these types of services. We cannot continue to give “no limit Mastercards” to pay for anything at any time for any covered person regardless of value and need but expect this to control overall costs in the long run.
There are programs out there that can address these issues head on before they occur without “predictive modeling” or accounting for savings for fewer sick days and decreased absenteeism. They control costs up front, before incurred by working directly with the patient and physician to properly identify the BEST treatment while eliminating any unnecessary activities. They will do this with an expected return of 3 to 10 times cost IN THE FIRST YEAR. These are pro-active programs to deliver the proper treatment rather than reactive cost control or pre-active spending hoping for future cost avoidance.
However, there is a caution…these are more active and intrusive programs involving medical management within the group. This will be done with knowledge to back up decisions combined with care and concern for the patient. Considerable effort is required to explain and implement the program in order to make it a more positive addition to the benefit program.
There is no “silver bullet” to kill the “werewolf” of ever increasing health benefit costs but there are concrete things that can be done. Some will impact costs right now measured in plan dollars not spent right now while others will spend more plan dollars now and bring in other measurements to try to “prove” savings or depend on future savings to come while adding to cost today. The choice is, as always, yours to make.