September 2019: Low-Hanging Fruit For Reducing Healthcare Overutilization

  • ADP has cited insurance industry experts estimating that employer-sponsored healthcare insurance premiums will have increased over this decade by 94% by the year 2020. For self-insured employers, the increase is equally devastating because premium rates correlate to rising healthcare expenses – paid by the self-insured employer.
Comparing Decades

One might think 94% is quite high as a number, however, consider a comprehensive Kaiser Family Foundation report showing that healthcare insurance premiums had increased 113% between 2001 and 2011. In comparison, the news is mixed in that the ten year growth, decade to decade, is decreasing slightly, however, it also means that your employer-sponsored healthcare expense will have at least doubled in this decade and we’re already in September 2019 and all eyes are on the next few years.

A related SHRM article, “For 2019, Employers Adjust Health Benefits as Costs Near $15,000 per Employee”, quoted the NBGH president and CEO: “Health benefit costs are still rising at two times the rate of wage increases and three times general inflation, “making this [cost] trend unaffordable and unsustainable over the long term”.

Proactively said, your organization’s healthcare expense will continue to increase substantially unless you take measures to reduce unnecessary utilization. This will reduce both future premiums and reduce direct provider payments made by self-insured employers paying through their TPAs.

Driving Up Healthcare Utilization

  • While those well-understood costs have been and continue to be sharply increasing, what about your employees who are on the job while in discomfort or pain today? Who are they? How do they contribute to the numbers? It’s well known that pre-injury employees experiencing discomfort consume a considerable amount of healthcare resources beyond obvious productivity loss. What’s more concerning is that healthcare utilization is by no means confined to traditionally perceived high-risk groups.

A number of major studies have been published, over the past decade, which have examined this topic with many thousands of employees at multiple employers. An example recent research project “Work Loss, Healthcare Utilization, and Costs among US Employees with Chronic Pain” (Disease Management & Health Outcomes, Volume 13, Number 3, 2005 , pp. 201-208(8)), studied thousands of full-time employees and the annual total costs experienced for medical, pharmacy and productivity.

This study was consistent with other recent studies and the authors confirmed: “The findings demonstrate that employees with chronic pain experience frequent sickness absences and short-term disability days and consume a considerable amount of healthcare resources.” The authors concluded: “Given the economic impact of chronic pain, employers and managed care organizations should evaluate the potential benefits in productivity resulting from workplace initiatives such as ergonomic modifications, rest breaks, or pain management programs.

Clients Speak Up

Over the past year, we have increasingly heard observations from our clients that, with employees bearing more and more of the costs of healthcare insurance and utilization, employees are becoming more and more reluctant to raise the pain or injury flags until such a stage within the pathology of an injury where intervention costs are great and the likelihood of success is greatly diminished.

This type of environment compels pre-injury employees to feel they’re unable to take time off for health reasons and so they seek assistance from their healthcare providers to help them to work through the discomfort and pain.

Much of the initial momentum of our clients was initially fueled by their common focus on identifying a practicable data-driven model of Office Ergonomics Risk Management. In some cases, they had extensive existing ergonomic programs in place and were simply seeking a cohesive bonding platform to connect their excellent yet sometimes siloed assets and resources.

Our clients identified the challenge of developing long-term positive behavioral change in employees regarding posture and pacing and needed an enterprise platform to consistently coach and empower employees, thereby integrally including them in the solution while supporting their professionals who manage the ergonomic process within their organizations.

The most effective way to curb “injury risk factors, presenteeism and productivity loss due to poor ergonomics” is to empower each employee who then receives an immediate and lasting direct benefit which rolls up to their employer. What can be better than helping your employees and your employer at the same time?

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