Self-funded healthcare insurance is on the rise among smaller and mid-size businesses looking to manage employees’ healthcare.

Through self-funded healthcare,  employers, rather than pay a hefty health insurance premium to insurers for their employees, “self-fund’’ premiums and assume most of the financial risk of employee health expenses. Employers pay claims through a third-party intermediary and can save significantly on premium payments.

In today’s rapidly evolving healthcare system, the percentage of workers in self-insured plans has been increasing. How do employers manage risk?

When it comes to maintaining healthy workforces, most employers face several challenges that could lead to significant costs if not adequately addressed. These challenges include managing chronic disease such as diabetes and hypertension; prescription drug costs and hospitalization costs – all of which make up the bulk of a company’s healthcare spending.

According to the Integrated Benefits Institute, U.S. workforce illness costs $227 billion a year in lost productivity when employees are absent due to illness or when they are underperforming because of poor health.

How does an employer manage costs while also improving the health of their employees?

One strategy is to catch diseases early. By implementing a comprehensive biometric screening analysis of employees, potential problems can be identified early. Biometric screenings check employees for risk markers such as weight, blood pressure, cholesterol and glucose levels.

With this aggressive outreach, companies can identify moderate-to-high risk employees and enroll them in a company-sponsored health and wellness program. As these employees improve their health, they fall into a lower-risk category, which helps lowers healthcare costs.

A large supermarket chain based in Texas, H-E-B, has seen these savings firsthand. “H-E-B’s internal analysis shows that annual healthcare claims are about $1500 higher among nonparticipants in its workplace wellness program than among participants with a high-risk health status,” according to a story in the Harvard Business Review.

Another strategy to lower healthcare costs is to focus on those employees already diagnosed with chronic diseases. Caring for employees with chronic disease drives a large portion of healthcare spending by way of doctor visits, hospital care, and pharmacy costs.

Managing chronic diseases can lower healthcare costs, according to a RAND Corporation study. Examining a large employee wellness program offered by PepsiCo, researchers found that “efforts to help employees manage chronic illnesses saved $3.78 in healthcare costs for every $1 invested in the effort,’’ according to the RAND Corporation.

Working with a healthcare provider that understands the challenges employers face is critical. Healthcare2U provides a network of direct primary care clinics so employees have convenient access to the healthcare they need.

Accessibility and convenience are two big factors that keep employees from going to the doctor and participating in programs that will keep them healthy and productive. By keeping employees out-of-pocket costs low and providing easy access to healthcare, employees can better follow medical regimens. An engaged patient is a healthier patient.

Direct primary care physicians know the value of controlling prescription drug costs to the employee and employer and the importance of prescribing generic prescription drugs when appropriate.

Our team of doctors act as healthcare advocates for employees and employers in reducing the number of unnecessary tests and procedures as determined by the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign.

The Choosing Wisely effort has garnered the participation of more than 70 medical specialty societies who have published more than 400 recommendations of overused tests and treatments that clinicians and patients should discuss.

Having a board-certified physician as an advocate can improve the health of employees while providing real savings in healthcare costs.

Healthcare is changing rapidly, don’t be left behind.

Living a healthy life encompasses more than just the right diet and exercise. Achieving health and wellness also includes a healthy balance of social, emotional, spiritual, environmental and the working worlds.

For the sake of brevity, we will focus on physical health – but the rest should not be ignored.

Physical health can be broken down into the three components: proper diet (including avoiding drug use and alcohol in excess), exercise and quality sleep.

Embarking on a path to healthier living should begin with an annual physical exam from your primary care physician. This will help evaluate cardiovascular risk factors such as weight, blood pressure, sugar and cholesterol levels, as well as sleep quality.

Healthy eating plan

A proper diet varies by the individual and is driven by whether he or she is trying to lose weight or maintain weight.

At the end of the day calories count.  It’s simple. If you want to lose weight you must consume fewer calories than you burn each day. If you want to maintain your weight, calories consumed should equal the calories burned per day.

Generally, to lose one to two pounds per week, you will need to reduce your calories by 500 to 1000 calories a day, according to the National Heart, Lung, and Blood Institute under the National Institutes of Health.

Many diets have been out there for years but the diets that minimize carbohydrate consumption or “low carb diets” seem to provide the best results. In multiple studies, these diets show better weight loss than low fat diets – along with the benefits of improved blood pressure and an impact on blood readings such as sugar, good cholesterol (HDL) and triglyceride levels especially in diabetic patients.

Regardless of the diet, the most important thing is to stick with the diet protocols – and not quit after you have lost weight. Maintenance diets are just as important as the initial weight loss diet.

Get moving

Exercise, contrary to popular belief does not – I repeat – does not help you lose weight without a healthy diet. The recommended minimum exercise of 30 minutes per day of moderate aerobic activity, however, at best can help you maintain weight.

A typical 30 minute workout will burn about 300 to 400 calories which is equivalent to two glazed donuts or a bagel with cream cheese. Exercise helps maintain weight as well as improve body image. It also reduces cardiovascular risk factors such as hypertension while raising your good cholesterol. Pick an exercise routine that is right for you and make sure it is at least of moderate effort to reach 50 to 70 percent of your maximum heart rate.

Quality shut-eye

Finally, good, quality sleep is critical in helping to start and maintain a proper diet and exercise regimen. We all know a bad night’s sleep makes for a difficult day with mental fatigue and decreased motivation.

The average person needs seven to eight hours of quality, restorative sleep each night.

The subjective definition of quality sleep as determined in a study by the journal Sleep is the feeling of being rested and restored upon awakening. This coincides with the number of awakenings in the night with the fewer the awakenings associated with the better quality of sleep.

“Good sleep quality is associated with a wide range of positive outcomes such as better health, less daytime sleepiness, greater well-being and better psychological functioning,” said Allison G. Harvey, PhD, of the University of California at Berkeley, lead author of the study in a story in Science Daily. “Moreover, poor sleep quality is one of the defining features of chronic insomnia.”

If one does not feel they are getting quality sleep, several diagnosis should be considered such as insomnia due to mental or physical stress, Restless Leg Syndrome and Sleep Apnea to name a few.

These concerns should be discussed with your primary care physician with a possible a referral to a sleep specialist.

July 2016 – Telemedicine is real and is dramatically changing how consumers receive healthcare.

Initially developed about 40 years ago to help alleviate a shortage of physicians in rural areas, telemedicine has developed into a valuable component in healthcare delivery and enables employees and employers to manage rising healthcare costs.

Formally defined, telemedicine is “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status,’’ according to the American Telemedicine Association.  Using tools like two-way video, email, and smartphones, telemedicine is used widely by hospitals, medical specialists and primary care offices to better serve patients and improve outcomes while saving money.

By providing near-immediate access to a medical provider via smartphone or two-way video feed from the job-site or home, an employee can have many issues treated virtually through a well-implemented telehealth program.

A study by Cisco showed 74 percent of consumers are open to a virtual doctor visit. By managing many acute illnesses such as colds, the flu and bladder infections or chronic issues such as diabetes or hypertension through an employer-provided telehealth service, employees and employers can save time and money.  Advantages include:

• Cost savings – By reducing emergency room and doctor office visits, significant savings can be realized immediately. Because diseases can be caught early and treated before they lead to something more serious, consumers can save through reduced hospitalizations and expensive procedures;
• Time and productivity – By reducing the time spent in emergency rooms and doctors’ offices along with less time out of the office, employees are more productive and, ultimately, healthier;
• Convenience – Scheduling a lunch-hour doctor’s appointment can be challenging in today’s busy working world. Using video or phone, consumers workers can follow-up with their physician for a follow-up prescription or a diagnosis and effectively manage health.

There are also some potential challenges, including:

• Electronic glitches — Loss of connectivity because of phone or computer failure or carrier outage can make communications a challenge. Also, not every patient is as electronically savvy to access telemedicine services;
• Low use – Many consumers are not aware of the telemedicine benefits available to them.

Telemedicine is rapidly becoming an essential healthcare strategy for small, medium and large companies.

More than one-third of United States companies currently offer telemedicine services and that number is expected to grow to 80 percent by 2018, according to Towers Watson.

While certain types of medical issues require a face-to-face exam, telemedicine is a key component of providing round-the-clock care.

At Healthcare2U, telemedicine is important to help make sure our members remain healthy while holding the line on costs.

Our cloud-based electronic medical records platform – which is compliant with the 1996 federal Health Insurance Portability and Accountability Act (HIPAA) – enables our team of medical professionals to maintain patient records and continuity of care between clinics and telehealth practitioners.

By deploying technology effectively, we are able to treat patients when and where they need it the most.

The current healthcare environment is one in which a physician is in a situation where he has to “pay the bills” or maximize charges with each patient visit. Doctors do this because without adding these extra, sometimes unnecessary, tests/procedures they would likely go out of business. They are forced to maximize charges because Medicare/commercial insurance reimbursements are too low. Of concern is the little time physicians can spend with patients because of the large volume of patients they must see in a day. Because of this lack of time spent, the physician in many cases cannot get to the root of the illness so must refer the patient to a specialist. This not only adds to the cost of healthcare but also exposes patients to procedures which in some cases are unnecessary and possibly dangerous. The bottom line is that the current system is not on the side of patients and employers.

This is why it is critical to have a Healthcare Advocate on your side. Whether an individual or an employer, you need a physician who will look out for your best interest not just financially but also to minimize your exposure to unnecessary medications and tests, thus reducing your chance of side effects and complications. A physician who can spend a little more time getting to the root of illness does not have to refer to pricey specialists as often or place patients on expensive medications or order expensive x-rays. This is the type of relationship that Healthcare2U is fostering between physicians and patients. This relationship can keep out-of-pocket costs down and reassure patients and employers that the system is on their side now. Whether you are an individual looking for an affordable primary care home or a large employer wanting to keep healthcare costs down, give Healthcare2U an opportunity to serve you.

John Rodriguez MD
Chief Medical Officer
Healthcare2U