Employers can encourage wise health care choices

There are 129 schools in the United States that teach people how to be a good doctor, but none that teach how to be a good patient and wise health care consumer.

When individuals learn how to be good patients and wise consumers, they benefit greatly in terms of their health as well as their pocketbooks. And their employers benefit as well, due to a reduced load on the health insurance plans they provide.

Unnecessary and improper health care use are major cost drivers, according to a recent report from the Wellness Council of America. Employers have unique opportunities to influence health care costs because they are in a position to empower and engage their employees as individual health care consumers.

One strategy municipal leaders can employ to help manage costs is self-care and medical consumerism initiatives that teach employees and their family members how to be good patients and wise consumers.

“Demand management” helps consumers manage their perceived need for health care services. Providing self-care information empowers people to make informed medical decisions, with or without provider assistance. Some solutions to help change use patterns are complex and costly, but demand management is relatively simple and inexpensive – and quite effective.

Many employers have begun to implement worksite consumerism programs to supplement their wellness efforts. Signifying the importance of such efforts, the Wellness Council of America is holding a two-day national training summit this fall called “Unleashing the Power of Medical Self-Care In Your Organization.”

The keynote address will focus on the following health care use issues:
• Use of the emergency room for non-emergency care
• Unnecessary hospital visits
• Unnecessary use of prescription medications
• Unnecessary use of brand name medications
• Choosing to receive care at higher cost hospitals
• Failing to receive preventive services
• Failing to comply with necessary treatment regimes

The National Ambulatory Medical Survey reports that there were more than 123 million emergency room visits in 2008, and a recent article in the Wall Street Journal found that approximately 30 percent were unnecessary. Unnecessary visits to the emergency room are increasing the waiting time for care. (The average wait is now more than three hours, according to the Wellness Council of America.) The demand for emergency room care is also driving up emergency room costs. The cost for the same treatment in a non-emergency room setting, meanwhile, can be three to five times less, according to the Wellness Council of America.

Even small changes, such as substituting generic drugs for brand name drugs, can save thousands of dollars. According to Blue Cross Blue Shield of Massachusetts, a month’s supply of the brand name drug Motrin costs about $56, while the generic equivalent, ibuprofen, costs just $19.

Using an MRI center instead of getting an MRI in a teaching hospital, or receiving care at a “Minute Clinic” instead of a doctor’s office or emergency room, can save thousands of dollars. Walk-in minute clinics, typically located in pharmacies, are staffed by nurse practitioners and physician assistants who provide treatment for common family illnesses and injuries, administer vaccinations, conduct physicals and wellness screenings, and monitor for chronic conditions. Minute clinics can be more convenient than many doctors’ offices because they are open during evening and weekend hours. Consumer co-pays are the same as for similar covered services at primary care providers, and a referral is not needed to receive treatment at these limited-service clinics.

A “consumerism” program
Common components of a self-care and medical consumerism program include the following:

• Nurse line: Most health plans offer a toll-free nurse advice line. These are generally free and accessible 24 hours a day, seven days a week. A report from Blue Cross Blue Shield of Massachusetts shows that, in one municipality, if just 10 percent of members who used the emergency room for non-emergency conditions had instead called the nurse line, and just half of those callers had followed the nurse’s advice rather than using the ER, the municipality could have saved about $3,000 and members would have saved a significant amount in avoided co-pays.

• Self-care books and guides: These inexpensive ($5-$20) tools provide information that helps increase efficient and appropriate use of medical services.

• Training: Many health plan providers will provide workshops for consumers, or hired speakers can do so. Because women make 75 percent of the health care decisions for families, it’s important to ensure that female family members are a part of the consumerism program. Women also account for 60 percent of all physician visits and spend approximately two-thirds of health care dollars, according to the American Institute for Preventive Medicine.

• E-education: Health plan providers offer many online resources, including cost and quality tools (e.g., “hospital advisor” or “treatment cost estimator” from Blue Cross Blue Shield of Massachusetts). Other useful sites include “My Health Care Options” (http://hcqcc.hcf.state.ma.us) from the Massachusetts Health Care Quality and Cost Council; the Partnerships for Healthcare Excellence (www.partnershipforhealthcare.org/employers); and Massachusetts Health Quality Partners (www.mhqp.org).

“Workplace-based medical self-care initiatives have been proven to reduce health care costs by significantly reducing unnecessary use of medical services,” says Dr. David Hunnicutt, president of the Wellness Council of America. “If effectively implemented, employers can expect an 8 to 18 percent reduction in the use of medical services – a significant amount for any employer.”

Self-care initiatives, he says, also “reduce absenteeism, increase productivity, increase employee satisfaction with their care, and increase employee empowerment and confidence in managing their own health.”

According to the Wellness Council of America, employers have documented a return on their investment ranging from 3:1 all the way to 20:1 for Workplace-based medical self-care initiatives.

Employers can learn more about designing, implementing and evaluating consumerism programs in “Worksite Health Handbook: A Guide to Building Healthy and Productive Companies” by Nico Pronk, president of the International Association for Worksite Health Promotion.

Wendy Gammons is MIIA’s Wellness Coordinator.