News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Employers and Health Insurers Jump on Wellness Bandwagon

Employers increasingly see wellness programs as effective ways to reduce the money they spend on health benefits. Health insurers are responding to these employer needs by launching wellness programs aimed at better prevention and disease management.

Such wellness programs often have two dimensions. First, most wellness programs encourage beneficiaries to utilize healthcare in a proactive mode. Beneficiaries are encouraged to receive regular medical check ups, along with preventive tests or screenings consistent with “best practice” protocols by age, gender and health status. This creates an opportunity for medical laboratories to develop services that can add value to the wellness programs offered by employers and health insurers. The second dimension involves efforts to improve lifestyles. Smoking cessation support, encouraging more exercise, and helping people lose weight are examples.

Over at Wellpoint, the nation’s largest health insurer, its regional subsidiary plans rolled out a wellness program called “360o Health.” This program bundles health and wellness programs together for employers. It includes Web-based health support and nurse counseling via phone. Online tools remind members when they’re due for routine tests and checkups or provide tips, such as recommendations on how to obtain less expensive medication options.

Wellpoint, which has 34 million members nationwide, also launched an assessment tool to gauge the program’s success. Its Member Health Index measures success of the WellPoint program in 20 clinical areas, including prevention, screening, care management and patient safety.

WellPoint, which tied its employee bonus structure to patient participation, reports it quickly realized a two-for-one return on its investment in the program, including a 10% reduction in hospital stays, according to a report by Modern Healthcare.

A recent survey of 350 employers by PriceWaterhouseCoopers indicated that just 15% of employees currently participate in wellness programs. Employers surveyed were most interested in programs that help employees lose weight, eat healthy, and reduce stress. They say their employees would be more likely to participate if offered incentives like premium reductions or gift cards.

Over at UnitedHealth Group, its OptumHealth subsidiary launched a project that compiles and analyses medical, pharmacy, behavioral health and laboratory data from claims, employer data and other sources. The goal is to use this information to identify the wellness needs of individual members based on health status. The company says its E-Synch Platform allows staff to take a personal approach to wellness, tailoring services to meet individual needs, and health goals.

Clinical lab managers and pathologists should recognize the market shift taking place as more employers and health plans jump on the wellness trend. This is a definite shift in clinical priorities and will require a different type of service support and test menu for laboratories and pathology groups. Patients in wellness programs need appropriate laboratory tests for screening different diseases and for predicting the patient’s likelihood to develop a chronic disease. This is a different emphasis for lab testing than, say, the 1980s, when most patients went to the doctor only after they felt sick.

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Doctors turn Tables on Payers with Satisfaction Ratings

When it comes to satisfaction ratings, physicians in Houston have turned the tables on payers! In a groundbreaking survey, the Harris County (Texas) Medical Society allowed physicians to rate health insurance companies. Results were made available late last year and were widely publicized across newspapers and healthcare magazines. It seems only fair that physicians, who increasingly find themselves rated by health insurance companies, should get the opportunity to turn the tables and rate the health insurance companies for the benefit of their patients.

“All insurers were rated very low by doctors in most areas, and the response was quite uniform,” said Kimberly Monday, M.D, a neurologist and Vice-Chairwoman of the Harris County Medical Society’s board of medical legislation. “The survey shows insurance companies are failing patients, doctors and employers who pay for healthcare services by creating ways and resistance to hold onto their money.”

487 physicians in Houston responded to the survey, which evaluated Aetna, Cigna, Humana, The Texas Blues, Unicare, and UnitedHealthcare. Here are some interesting statistics from the survey:

  • More than 65% of the doctors reported they have experienced difficulty getting their patients’ medical services approved.
  • 69% have problems with prompt payment, and 64% say they are paid less than their contracted rate.
  • 58% say their patients do not understand benefits, copayments, deductibles and limitations of their coverage.
  • 65% say their patients rarely understand preventative services and care-coordination services available to them.
      The Harris county group is not the first medical society to conduct a survey on health insurers – the Colorado Medical Society has conducted several similar surveys. The difference is that Harris County chose to make their results public and transparent. In the age of transparent healthcare services, this will probably become a trend. This means that health insurance companies may need to pay as much attention to physician satisfaction as they do to employer and beneficiary satisfaction.

      For laboratory administrators and pathologists, the attention garnered by the Harris County Medical Society physicians’ rating of payer services demonstrates how transparency is opening up new channels of information for the public. Many patients are smart enough to know that if their health insurance company treats doctors poorly, that can affect both the patients’ access to care and the quality of care they receive. That is why public disclosure of physician satisfaction with different health plans can trigger improvement in how payers work with providers.

      Related Articles:
      Health insurance companies are failing patients, businesses & physicians, say physicians

      Turning the tables: insurers win low marks in doc-satisfaction survey (Modern Healthcare subscription required)