Most of the companies in the U.S have been implementing several initiatives to develop an efficient health care plan for their full-time employees so that they can receive affordable coverage (with payment not more than 9.5% of their salary) as insisted by the Affordable Care Act. The latest CNN report cites the opinions of America’s famous healthcare experts Tom Emerick and Al Lewis about cracking healthcare costs. According to that report, Workplace Wellness programs can’t reduce the healthcare costs as they are supposed to have done. The savings are very less even if we consider the participation of both committed employers and motivated participants. An article published by the Journal of American Medical Association also asserts that visiting doctors frequently for more tests, as advocated by most of the wellness programs, is simply a waste of money. The report puts forth five initiatives to cut healthcare costs rather than opting for state health insurance exchanges or penalties as alternatives to wellness program.
Curb Unnecessary Health Checks
It is a bad practice to persuade your employees to go for unnecessary health checks even as a part of the wellness program. This will increase the medical spending and lead to over-treatment which may prove hazardous to individuals. Frequent biometric screenings is a perfect example for that. The unnecessary tests, biopsies and surgical procedures generated from this screening are ineffective and cost around $1 million. Emerick and Lewis say that you need to screen 4,000 people incurring a cost that exceeds $1 million to prevent even one $50,000 heart attack. Moreover, the false diagnosis rate in the case of cancer screens is very high. The National Heart, Lung, and Blood Institute even opposes unwanted biometric screenings as it results in over-treatment.
Fire Health Care Consultants
Healthcare consultants who helped to implement the programs to reduce healthcare costs and failed can’t be trusted any more. The failure signifies the fact that they may not have evaluated the pros and cons of the programs thoroughly. Fire such consultants and employ new consultants. They will evaluate the programs more efficiently. The cost will be reduced as well.
Spending money for health insurance brokers is also a very good option. Insurance brokers can help employers find suitable health insurance for their employees. They will check for better plans and premiums and negotiate with the employers. The companies can thus find a better deal which can cut their healthcare costs. Apart from that, they can help employers settle benefits issues and assist them in employee enrollment.
Conduct Eligibility Audits
If you audit the claims submitted by your employees against the insurance policy, you can ensure that the claims are paid only to the employees who are actually eligible for the health benefit. You may feel that knowing who are the people eligible to have which claims paid seems like Health Insurance 101 and would bring no savings. But, if you get support from professional medical billing companies which ensure 100% contingency-based audits, you can review every portion of the claim, eliminate serious mistakes and reduce inaccurate costs. In this way, you can save lot of money that you may otherwise spend unnecessarily.
Negotiate with Prescriptions Benefit Manager (PBM)
Prescription Benefit Managers often hide their profitability with rebates, low or unrealistic direct fees, implementation allowances and other contractual clauses. Therefore, it becomes impossible for the employers to estimate per-drug markup of PBMs and adjust the healthcare costs accordingly. It is better to negotiate that markup with PBMs directly.
Better Care for Employees with Unpreventable Health Conditions
Normally, a small percentage of employees generate large percentage of claims on account of continuous health needs. But, if you focus your wellness program on the 80% that generate just 20% of the claims, it means you are neglecting the outliers who have health conditions that were not preventable. Wal-Mart, the retail giant offers free travel for their employees to find destinations across the country which specialize in treating the particular health condition and thereby cut health costs significantly. The facilities you offer should be such that your employees can get back to work soon. Hence, focus only on medical destinations that ensure (and agree to get paid for) positive results.
Being an experienced medical billing and coding company in the U.S., OSI is dedicated to staying abreast of the latest industry guidelines. Our services provide comprehensive support for the success of your practice.