The true path to controlling healthcare costs

Implementing meaningful programming and mitigating risks are some of the most important things I do in my role as a Wellness Program Manager. I work for Phalcon Ltd, a multi-state electrical contracting, utility construction, industrial and energy infrastructure, and facilities services company. Two years ago, I thought the wellness program I built had everything covered to help improve health and save money. Then I learned what it really takes.

Understanding where the answers live

Our wellness program began in 2012 as a simple, grassroots effort. Today, it has grown into a robust multi-faceted wellbeing tool for employees, their spouses and dependents. Despite the program’s growth and success, Phalcon, like many employers, continually faces rising healthcare costs.  

In search of a solution, I explored the possibility of mitigating every risk in our covered population. Unfortunately, I learned that is just not practical. However, what I did learn is that there is a way to discover large risks and gaps between a population’s needs and the benefit plan design and wellness program. Having that information paved a way for me to start improving my employee’s health and employer’s savings.

New thinking for a better strategy

In 2014, my company hired BlueBack Health as a consultant to the leadership and benefits team to help us find real ways to save money if at all possible. Through this initial year, BlueBack Health’s Founder and Principal, Eric Thompson took a different approach. Instead of shifting risk or raising deductibles, Eric spent time reviewing claims and analyzing our employee population’s health. He then proposed some innovative ideas to propel our wellness program and benefit plan design in ways far beyond what our current broker was able to provide. It was then that I started to gain a glimpse into new strategies that can shed light on the actual drivers of cost.

As part of a cost savings program, BlueBack Health worked with our benefit carriers to review preventable costs such as emergency room visits or brand name prescription drugs and make advisements to the Phalcon HR team. They also provided an immense amount of guidance and support to Phalcon’s wellness program. They became an active member of our wellness team, attended all our monthly committee meetings and scheduled separate strategy sessions with me to discuss opportunities for more impactful wellness programming.  

Concurrently, Eric educated Phalcon’s leaders about the advantages of self-funded medical plan options, and in January 2017 we converted.  This was a crucial step in helping us better understand our healthcare costs and how to reduce them. With the transition to a self-funded option, our carrier was able to provide Phalcon with far greater access to our population’s health data. The goal was to leverage this information to inform and improve the design of our wellness programs.

Still, questions and concerns persisted

In 2018 we had our highest claims year, and our leaders were looking for answers. Was our wellness program working, or worse, was it failing? What were our next steps if this trend continued? What more could be done?

We committed to stay the course and continued to review our data. In doing so we learned that Phalcon fell below the average in preventive screenings. Our emergency room usage was high. And our population had many of the typical American risks: high blood pressure, elevated cholesterol, excessive body weight. And because of these conditions, prescription costs were rising. How could we change this dynamic?

From confusion to enlightenment

I did not believe that our program was not working, but I suspected something was missing. What was driving this high claim year and how could we combat it? Of course, I was getting some information from our biometric screening events and wellness providers, but this information was only coming for those that participated. What about everyone else? What about the spouses and dependents on our plan? What weren’t we getting in the story from our carrier? Could that play a role in containing or controlling costs?

Eric knew there were better options for the Phalcon team.  He introduced Phalcon to Springbuk, a health analytics software solution. Through Springbuk’s health intelligence tools, Phalcon gained deeper and more detailed insight into our medical and wellness data. We suddenly were able to move beyond the traditional notions of high cholesterol, high blood pressure, or elevated BMI. And we were able to see our population as a whole – even those not participating in our wellness program.  

By creating focus groups, we were able to showcase that the breakout group of senior leaders at our company had lower compliance with preventive care than our remaining employee population (13% compliance versus 37% in 2019). Leading by example? We knew where we needed to up our game. The Wellness Council of America’s seven benchmarks for workplace wellness starts with ‘Committed and Aligned Leadership’ as the first and most important measure towards program success. (1) Springbuk helped me persuade my leadership to get more involved with our program events as we entered our 2019-2020 wellness year. It worked. Awareness and compliance is increasing company wide. 

Creating a measurable impact

The bottom line is this: without detailed data on an updated basis, it is not possible to have a comprehensive picture of your entire covered population, nor fully serve the needs of your people. Wellness programs are useful benefits for employees and their families. But in order for them to reach their full impact potential, they need to be designed around the most real and prevalent needs. Having the right type of data on hand, we are now more nimble, and able to respond quickly to real-time situations versus annual tweaks based on spotty carrier and biometric data. We can also deploy targeted communications and education to population subsets to better manage chronic conditions, something we are implementing now in 2020. We believe this will help us strategically address the real drivers of cost, and put us on the true path toward significant cost control.  

Phalcon was featured by Springbuk in a case study for their innovative ways to use the tool. Download the full case study here. 

References

Rauch, R. P. (2018, July). 7 Benchmarks. Retrieved from WELCOA

About Springbuk

Based in Indianapolis, Indiana, Springbuk is a health analytics software solution. The company’s health intelligence platform unifies medical claims, pharmacy, biometric and activity data. The predictive modeling engine helps employers target their engagement with pinpoint accuracy, forecast overall healthcare spending, identify at-risk employees, and measure their wellness programs. [Excerpt from LinkedIn page]

About Phalcon

Phalcon, Ltd. is a leader in utility construction, electrical contracting, industrial and energy infrastructure, and facilities services. Phalcon combines the cross platform expertise of over 1,800 employees from operating companies to provide specialized combination engineering and installation expertise to clients.