Execs Say Be Heard, Seek Help On Options

Experts in finance, health, insurance experts recognize uncertainties, outline steps business owners can take now

Read more: Execs say be heard, seek help on options - Dallas Business Journal

"You don't have all the answers, but you've got a focus," said Beth Acton, the chief financial officer at Comerica Inc. "You've got a governance process, and you've got the right people involved to get input on what's happening. If you don't know what's happening around you, you're going to miss some ideas that maybe would have been a better product for your employees and/or more cost effective."

Dan Prescott, a partner in Prescott Pailet Benefits, said the planning needs to include flexibility.

"The plans for two or three years down the road need to be written in pencil because there's going to be some erasing that has to take place."

And even though many employers have fewer resources, they still need to make themselves informed and engaged while the administrative rules are being drafted, said Joel Allison, president and CEO of Baylor Health Care System.

"This is just a time to be very diligent," he said. "Use every resource you have available to really understand and continue to monitor what they're writing and be sure they're writing it to follow some legislative intent."

Scott Flannery, CEO of UnitedHealthcare, agreed.

"I would tell employers to voice their opinions. Don't be complacent. You need to be vocal to your local representative, to your associations, to your boards ­— all those entities you come in contact with. Because this isn't done yet."

'Throwing their hands up'

All four executives acknowledged there is tremendous uncertainty. Acton cautioned that the reaction could be harmful.
"I think what we will see is uncertainty drives cautiousness on the part of (our) customers, whose natural reaction is to pull back. They say, 'I'm not going to add people.' Or 'I'll add only part-time people.' So the impact of (health care reform) will be slower growth in the U.S. economy.

"From a small business side, particularly our customer base, they're throwing their hands up," she said. "They are confused. They know it's going to be more costly, they don't have internal resources to help, and, frankly, I think it's going to have an impact on their hiring in the future."

Flannery and Allison said while there is uncertainty and cautiousness, health care providers and insurers already are creating new programs to steer how the federal government fills in the administrative blanks in the legislation.

Innovation won't come from the legislation, but from the programs that providers and insurers are creating, Flannery said.

"Baylor is very innovative around medical home and accountable care organizations," Flannery said in a nod to Allison's health care system. "We've been pretty innovative over the last five years around our premium designation program, which basically assesses physicians for both quality and efficiency and then denotes those for the folks that we provide care to.

"All those things are innovations from the private sector, not from the government sector, and those innovations are going to drive what reforms or what modernizes health care over the next three or four years."

Uncertainty about what will be deemed acceptable under the reformed health care system threatens innovation, Prescott said.

"We have to take a step back because we don't know if our solution is going to fit in their guidelines," he said.
Allison said the Baylor system is not stepping back.

"When we saw the Washington discussion about health care reform over a year-and-a-half ago, we rolled out Vision 2015 and said 'We're not going to wait on Washington.' That's what's great about the private side, and why we need to keep that private side in there."

"I'm optimistic we can influence these rules and regulations through pilots and programs."

Time to 'educate and motivate'

Prescott said while providers and insurers are doing a good job on innovation, there is a disconnect with many consumers.

"We have not done a credible job of educating our insureds, the users, about the questions to ask, the phone calls to make, to push the physicians and hospitals themselves on the best ways, practical ways, of using their health care," Prescott said. "If we don't start to educate and motivate these end users and their covered spouses on the best ways of using their program, they're bound to continue to repeat the same type of problem. We're a capitalistic society. If our customers start to push us and tell us what they're looking for, we're going to provide it because we want to keep that customer. But it comes back to innovation and education."

Flannery said the industry is providing a lot of information.

"So what's the onus on the actual consumer to go out and get it?" he asked. "A good example of this, and I read this in an article several years ago, is you can actually go out and spend 10 times more time researching a large-screen TV than you can a heart surgeon."

Find the right carrots and sticks

Employers and health care providers need to give employees incentives to live healthy lifestyles, but they also need penalties for people who don't drop bad habits, Flannery said.

"There's got to be a carrot or a stick, depending on the employer and what their culture is, around how we engage our employees," Flannery said. "One example is a wellness program. What do you do with employees who refuse to participate in it? It's time to be motivated to help drive down health care costs."

"Corporations need to move toward plan designs that align employees' needs for use of health care with the costs," Acton added. "So if they're ending up with the costlier thing, they need to pay for that, which will absolutely change their behavior. That, to me, is a very important thing that employers are going to have to look at over the next few years."

Most employees won't improve their habits without financial incentives, Prescott said.

"Until people have to pay for their vices, until people have to pay for their problems, until they're engaged financially, it's hard to grab their attention," he said. "So when a smoker pays the same as a nonsmoker, from a financial perspective on their insurance benefits, there's little reason for them to stop smoking.

Allison said Baylor Health Care System is seeing results from the cash bonuses it gives employees who fill out health care questionnaires and from other awards for participation in fitness and disease-management programs.

"There is that carrot, that incentive," he said, "but there's also going to have to be some way that there is that penalty, in that you can charge more for the smoker as opposed to the nonsmoker."

"In the end, the carrot and stick changes behavior," Acton said.

Get your workers well

The group agreed wellness is important, particularly to increase productivity. Financially, though, Prescott and Flannery said small and midsized companies are challenged to reap the benefits.

"The financial perspective of what's being offered by many of these stand-alone wellness carriers, vs. what they're getting for an ROI is not there as much on the small and midsize (businesses) and it's not showing up in the pricing of insurance contracts, either."

"What happens in the smaller employment areas is, it's driven by price, and rightfully so because price is king in the smaller arena, so there's not a track record established," Flannery said. "If you look at the longevity of the smaller business in a program vs. a larger business — a Comerica or a Baylor — there's more consistency. There's not an up and down, peaks and valleys. So I think the return on individual is the same, but to realize it through all that turmoil and all that change is much harder to quantify and much harder to prove out."

Baylor's wellness program has shown physical and fiscal results, Allison said.

"For several years we've had a program called 'Thrive.' It's been very successful. We are very strong on wellness and prevention, and we are a large employer, and we've actually gotten a return on it because we've reduced our overall cost of health insurance 8.5 percent. It's a significant dollar amount just to bend that curve, as they say. Anything that we can do to emphasize that, we think, is a good return for us ."

Get good help

Getting information and help was a clear message from the group, with Prescott and Flannery noting that price is only one factor in choosing a broker and a plan.

"There's the dollar you're spending today vs. the dollar you may have to be spending tomorrow," he said. "(Employers) need to be wise to that, and because they're business owners, you would hope they would be thinking down the road."

"Over the past four or five years, for us, not only to be selected as carrier but also for the consultant, the broker, it's become a bidding war," Flannery added. "It seems like he who is the lowest wins most of the time, and that's not always the best for the employee. Some of the things I think (employers) should take into consideration is technology and data analytics. One of our mantras at UnitedHealthcare is better information, better decisions."

Prescott easily ticked off several questions employers should ask."You should be asking your benefit adviser what kind of education and communication tools they have," he said. "How would they unveil a new program? Who would they bring to the table? What kind of technology do they bring to the table? What kind of claims assistance do they bring to the table? You want to talk about what does the product mix look like."

Acton pointed out that surveys show most people who have coverage through their employers are satisfied with it.

"To migrate to some other eventual outcome (such as public insurance) is in conflict with the desires of most employees," she said.

The bill didn't cover everything

The health care bill addressed access to care, but didn't address how to assure that health care services are high-quality and efficient, Flannery said.

"The health care reform bill is really more about modernizing health care and how we deliver it," he said. "The reform in this bill, as we envision it, is just the first step of many down the line."

Allison said the hospital and physician reimbursement mechanisms in the health care bill don't put enough emphasis on quality of care and patient outcomes.

"It doesn't go far enough," he said.

Read more: Execs say be heard, seek help on options - Dallas Business Journal

About Baylor Scott & White Health
As the largest not-for-profit health system in the state of Texas, Baylor Scott & White promotes the health and well-being of every individual, family and community it serves. It is committed to making quality care more accessible, convenient and affordable through its integrated delivery network, which includes the Baylor Scott & White Health Plan, Baylor Scott & White Research Institute, the Baylor Scott & White Quality Alliance and its leading digital health platform – MyBSWHealth. Through 51 hospitals and more than 1,200 access points, including flagship academic medical centers in Dallas, Fort Worth and Temple, the system offers the full continuum of care, from primary to award-winning specialty care. Founded as a Christian ministry of healing more than a century ago, Baylor Scott & White today serves more than three million Texans. For more information, visit: BSWHealth.com