You probably can’t help but notice lately all the reports about the Supreme Court hearings on the Affordable Care Act (healthcare reform). This is a heated topic in the U.S. because the American health care system is almost unique in the extent to which it funnels health spending through employers. While most of the big developed nations use some type of universal single-payer system that socializes health costs across the entire economy, about 60% of U.S. health care spending goes through employers via employer-sponsored medical insurance. So while U.S. employers are heavily impacted by health care expenses, many of those companies’ competitors in the global economy don’t bear those costs.

While I am not commenting either for or against the Affordable Care Act, I wanted to share with you an interesting report about how employers out there feel about it.

The survey, from GfK Custom Research of North America, found that 56% of the 502 privately held companies questioned said they were likely to continue offering their employees health insurance even if the insurance mandate portion of healthcare reform is enacted as planned in 2014. Just 12% said they would be “very” or “somewhat likely” to drop coverage, while about a third said they didn’t know what they’d do.

This is important, because by providing your employees with health insurance, you are privy to much more data about their health (on a macro level, of course, not on an individual level). This provides important information that can guide your investment in employee wellness. After all, if 35% of your employees have diabetes and/or are overweight, you know where you’re going to focus your spending, right?

Also, when you provide the insurance, you also have more control over the quality of that insurance and the care provided. That’s because you can require that health plans and their providers meet certain evidence-based parameters shown to improve health-related outcomes. This, in turn, could keep your costs down by preventing acute exacerbations of chronic conditions like diabetes, asthma, and heart disease that could otherwise be managed.

All is not completely rosy with the employer/healthcare reform dynamic, however. The GfK survey also found that many employers fear that the new law won’t slow cost increases, or might make costs worse. How it will impact U.S. employers will depend partly on the Supreme Court’s Obamacare decision in June. I believe the results could be dramatic for America’s health care system.

Employers’ ability to control costs will depend on two giant decisions. First is the Supreme Court’s ruling on the constitutionality of the individual mandate. If the justices give it a thumbs-down, employers are in a quandary. They like a mandate because it could lower their insurance costs by forcing more people into the risk pool. And in a world where everyone is legally required to maintain insurance, employers may feel less pressure to offer it, and their costs would likely decrease as they encourage more individuals to purchase their own health insurance through the new insurance exchanges. If the mandate is voted down, employers may choose to continue doing what they’ve already been doing—increasing copayments, deductibles, and premiums.

If the mandate is upheld, then everything depends on the second big decision: the voters’ choice in November. A Republican sweep would probably mean Obamacare’s repeal, while a more muddled election result probably wouldn’t.

One part of the law that can help large employers is the medical loss ratio component. This part of the law, which just went into effect, requires that at least 85% of every premium dollar be spent on actual medical or preventive costs, not marketing or administrative costs. Hopefully that will provide some savings. The good news is that if health plans don’t meet the ratios, they are supposed to refund some of the overrun to you, the customer.

So have you figured out your position on healthcare reform yet? Assuming the full force of the Affordable Care Act is implemented, how do you see it affecting your business?

Bob Fabbio
President & CEO
WhiteGlove Health, Inc.

You know what’s behind stratospherically increasing health costs in this country? Not just more expensive equipment, drugs and procedures, but a population—even a working-age population—with one or more chronic health conditions. I’m talking about diabetes, hypertension, cardiovascular disease, arthritis, congestive heart failure, depression, asthma, and more. Manage these medical conditions with lifestyle changes and, where necessary, medication, and we can save billions. But let them get out of control and we’re spending billions on emergency department care, hospitalizations, surgeries, and more intensive acute medical care.

One place where the focus on chronic disease management is particularly important is the workplace. Yet I was disappointed to read a recent report from Towers Watson Consultants on employee wellness, which found that just 59% of the 3,099 employees they surveyed said that managing their health is a top priority, down from 69% in 2008. The survey also found fewer employees participating in lifestyle management programs, with just 59% saying they were taking actions to significantly improve their health, compared to 65% in 2008.

But, and here’s the rub, just a third of employees said their employer offered programs designed to help them live a healthier lifestyle. We know the percentage is far higher. We also know, as you may have read in one of my earlier blogs, large corporations also surveyed by Towers Watson said they were making significant investments in their employees’ health and wellness and reporting good returns on that investment. In fact, nearly 90% of US companies said that health and productivity is a core component of their organizational health strategy. The report also found that spending on health management programs in the US has grown 50% in the past two years.

So what does it take to get employees more interested in their health? Well, increased deductibles and copayments is one option. After all, if it costs a $150 copayment to be seen in the ER for an asthma attack versus a $10 copayment to see your doctor for education and management, which do you think cash-strapped employees will choose?

Your job as an employer is to help them understand the differences and the fact that they have control over the outcome. Staying with the asthma example, show them the potential costs savings over time, how to use maintenance medication, track their lung function, and implement their action plan at the start of any breathing difficulty—not when they are having so much trouble breathing they need to be seen in the ER.

Conversely, offering reduced premiums to employees who meet certain health-related parameters—losing weight, controlling their blood sugar, quitting smoking—provides a “carrot” approach also shown to be quite successful.

Also ask yourself how well you’re marketing your wellness programs. The reality is, these programs should be marketed just as aggressively to your employees as you market services and products to your customers. It really takes employers to be very intentional about changing the behavior of their employees and dependents. If they are not, very little will change with respect to their healthcare spend.

So, how are you marketing your wellness programs, and what kind of participation are you getting? Are you getting the kind of results you would like?

Bob Fabbio
President and CEO
WhiteGlove Health, Inc.

1. Treat It
An important part of diabetes management is knowing when and how much medication to take. Follow your doctor’s orders.

2. Feed It
Another cornerstone of diabetes management is healthy eating.

• Eat balanced and varied foods every day.
• Do not skip meals.
• Avoid snacks.
• Don’t over eat.
• Eat foods high in fiber (20 to 35 grams per day.)
• Stay away from desserts and sugary drinks that have empty calories.

3. Move It
A regular exercise program can improve blood sugars, decrease the risk of heart disease, and help you lose weight. Exercise at least three to four times a week for 20 to 40 minutes each session.

4. Don’t Do It
Avoid smoking and alcohol. Alcohol interferes with the liver’s ability to release stored sugar.

5. Drink It
Drink plenty of water.

6. Coordinate It
Match your mealtime schedule to your insulin schedule as explained by your doctor or Nurse Practitioner.

7. Get Your ZZZs
Get plenty of sleep. Keeping a regular schedule and getting enough sleep will help you keep your blood sugar levels in good control.

8. Manage It
Manage stress as best you can. Keeping your stress under control helps to keep you blood sugar under control.

9. Check It
Practice good foot and skin care. Check your feet and skin for discolorations, cracking and swelling. If you have concerns, contact your doctor or Nurse Practitioner.

10. Learn It
Continue learning about diabetes to maintain and improve your health. The more you know, the better you can control it.

WhiteGlove’s Mobile Chronic Care Membership Services help you proactively, conveniently, and affordably manage your chronic care needs. Our Mobile Diabetes Management service includes:

• Medical care that comes to you – wherever you are in our service areas
• Free phone consultation and follow-up – dedicated clinical resource to answer questions
• Automated scheduling of in-person, phone, and diagnostic test visits – automated treatment plan according to national standards of care
• Generic prescription medications – medications are prescribed and delivered
• Referral to specialists when needed – actively include other providers when needed
• On-line access to health information – medical histories, labs, visits, Rx meds, etc.

These services are based on national standards of care and are available to anyone within WhiteGlove’s service areas in Arizona, New Hampshire, Massachusetts, and Texas. Other Chronic Care services offered by WhiteGlove include Blood Pressure, Cholesterol and Thyroid management.

QUESTION and ANSWERS: Do you have other tips or ideas? Please share a comment with us. If you have further questions please send them directly to questions@whiteglove.com and we will get to them as quickly as possible.

See all the WhiteGlove Self-Help posts.

Liz MacDonald
Social Media Associate – WhiteGlove House Call Health

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