Wellness programs help keep claims in check

By Kim Kilday, MBA, MHA
Director of Marketing

At this time of year, it is not uncommon for county staff to comment, “This renewal is so high. If claims are the culprit, then how do I fix it?” If claims were the only issue, counties would have an easy time of reducing costs. To truly understand the issue, it is important to take the analysis a step further and examine the underlying causes for the claims. This is true when reviewing both Workers’ Compensation and medical claims.

The good news is that counties are taking a serious look at what they need to do to keep claims costs from rapidly escalating. Some counties are developing in-house wellness programs with dedicated full-time staff to help employees maintain healthier lifestyles. The critical success factor for any program is to provide access to the tools that positively shape the behavior of employees. Having management relay messages shows staff the importance of participating in the wellness program.

Teaching employees and supervisors about the costs of providing health-care benefits helps them to understand how they can positively impact these costs. That does not mean employees should be discouraged from accessing their health-care benefits. The issue is changing perspectives and behaviors.

One county initiated a public relations campaign this year to inform employees that claims costs were increasing. Staff was encouraged to attend a board meeting at which a review of medical benefits renewal showed higher than predicted claims and a low participation rate in the free-of-charge disease management programs offered by the county. As a result, the county was forced to change the benefits offered to employees in order to provide coverage.

None of these choices were pleasant for the county manager and management team. As the county looks to the future, it is hopeful that employees will take control of their own health. The county is also planning to develop a wellness program that parallels the disease management programs offered to them through the Pool.

Some counties are conducting presentations with their supervisors to review how Workers’ Compensation rates are developed. Through reports provided by the Pools, counties have the ability to show which departments have the highest claims amounts, as well as the cause of those claims. The stage is set for departments to show a line item for Workers’ Compensation claims instead of the county manager’s office shouldering the burden of claims amounts for the entire county.

Another county is using the class code rates based on payroll to redirect the cost to each respective department. This shift in perspective of who is paying for the cost of claims establishes the mindset that it is only when a department “pays its own way” that there will be recognition of the seriousness of containing claims costs. Heightening the awareness of department supervisors who are closer to the everyday exposures allows them to look at processes and how employees do their job to help decrease claims costs. It sends the message that supervisors are responsible for ensuring a safe environment for their staff, and that it is critical to educate staff members on how to do their job safely without injury.

How does a county know which programs are best? They review their performance from a claims perspective with the assistance of their claims administrators for all coverage lines. This helps a county to reveal at-risk behaviors that exist within their employee population. Analysis takes the guess work out of what kind of safety and wellness programs are important.

Once the claims review is complete and counties have an idea of what accidents, diseases and illnesses to focus upon, it is critical to survey employees and find out what activities and types of exercises interest them. Looking at their current activity levels gives some indication of possible participation. Offering what an employee will use because they have provided feedback as such will help with satisfaction with the program. A happy and healthy employee will have a lower rate of absenteeism and will recover quicker from an injury or illness.

While wellness programs are designed for all employees, in many instances they only reach the employees who already lead a healthy lifestyle – i.e. those who exercise, eat properly and don’t smoke, for example. The key is reaching those individuals who view themselves as healthy but may have a serious health condition that is being untreated or is undetected. Numerous accounts from around the state indicate that when baseline testing was conducted at the inception of a wellness program, employees were identified as at-risk for a cardiac episode and would have incurred high claims had they gone undetected. Early intervention is the key with a wellness program.

While the analysis component can be time-consuming, it is the most critical. When a wellness or safety program is implemented, it typically is in response to something – in this case high claims. What must be reviewed are the underlying elements that cause claims.

Accident review committees can review preventable injuries and make recommendations to decrease the frequency of those claims. An employee health committee supports the desire of management to provide access to various programs that will aid employees to make healthy choices for themselves.

The next task is to take actionable steps that provide the resources to employees that will help them change their behaviors. Further compounding the challenge is convincing management that an investment today is an investment in the future. Return on the investment may not be immediate because it takes time for behavior to change, for employees to get comfortable with their employer providing access to programs, and for employees to safely and steadily get healthy. Once management has given its OK to proceed, counties have the challenge of convincing employees that wellness and safety programs are a positive resource for them.

Counties have resources available to them through the Risk Management Pools, Loss Control with Marsh, and CIGNA to help with planning and initiating safety and wellness programs. With a number of counties beginning their own programs, the Pools have the ability to connect members to learn what the challenges and successes are with beginning a program.