Dealing with uncertainty

Just before an Obamacare replacement bill passed in the House of Representatives, local health care executives gathered to discuss how their organizations are dealing with lingering market uncertainty.

From the pages of In Business magazine.

When we convened this industry roundtable on health care, there was still a chance the Affordable Care Act (aka Obamacare) would be repealed and replaced, but there was also a chance that the Republican-led Congress — both the House of Representatives and the Senate in combination — would be unable to pass meaningful legislative changes this year.

While leaders in the House were rounding up enough votes to pass a replacement bill called the American Health Care Act — finally addressing the issue of coverage for people with pre-existing conditions to the satisfaction of moderate Republicans — we spoke to a panel of local health care executives to discuss the uncertain situation and found that no matter what takes place, their organizations are ready to adjust to a new reality or live with the ACA.

Todd Burchill, vice president of business development, UnityPoint Health – Meriter
Mike Weber, executive director of sales and client services, Dean Health Plan
Scott Kowalski, executive vice president, WPS Health Insurance
Moderator: Joe Vanden Plas

VANDEN PLAS: How should the various stakeholders — employers and health systems — deal with the uncertainty surrounding federal health care legislation and the potential ramifications of a new law?

WEBER: First of all, we’re committed to implementing the existing law (ACA), so that’s a priority for us. Our commitment is to make sure we’re following all the guidelines. We actually have to follow a couple of different fronts right now. We have to prepare for the future, but we also have to take care of things that are status quo, so that’s drawing us into two separate paths. We’re getting a lot of input from people who we believe are close to the government to make sure that we’re well prepared, but we’re very much committed to the ACA as it stands today, but then preparing for the future if it changes.

The one thing that we are finding in the marketplace is that people need advanced notice. The first year after the ACA came out, we had 300 meetings externally in the marketplace to explain to members, to providers, to people who were interested bystanders, about what the ACA was. Over the last few years people have gotten used to it. Consumers have become better consumers, they ask us questions that need to be asked, and so we’re learning from what we did in the past and we’re trying to prepare for the future. What we’re really hoping is that we have some leeway and some time to educate our members and our patients.

VANDEN PLAS: What kinds of questions do they ask?

WEBER: Insurance and health care is a very personal decision. When you think of health care reform, we talk about it at the government level. So people always think ACA, how does this affect things, and they talk about percentages, the number of people insured, but what I’ve really seen in the marketplace is that it comes down to an individual decision. They want to know whether their doctor is in it. They want to know the cost. They want to know how much things have changed, particularly people who have serious health conditions. They want to know if it’s going to be covered.

The next phase is obviously the financial phase of the taxes and things like that, but when we had those meetings, they were very powerful because for the first time in history people who had [pre-existing] medical conditions knew they were going to be covered, and that was very different. Years before that, you would come to me and you would say, ‘Hey, I have this, this, and this going on. What do you think?’ And probably the standard answer for a lot of carriers would be, ‘Well, fill out your application and we’ll see,’ while kind of knowing in their hearts that maybe they would not be covered. What’s changed today is that people want to know if their providers are in it, they want to know the cost and the benefits, and that’s really changed since the beginning of the ACA.

“The positive is that it’s pushing us, as health care systems, to be more transparent with our pricing and be able to educate the market on what things are going to cost.” — Todd Burchill, UnityPoint Health – Meriter

BURCHILL: I’ll take it from the health system approach, and while we’re certainly watching what’s going on, from a health system perspective it’s really not going to change our overall strategy. Whatever comes out of the ACA, we’re focused on trying to continue to transition ourselves to a value-based health care system, continuing to transition out of the fee-for-service and volume-based world and into more of a value-based world. I don’t really see that changing our overall strategy, whatever comes out of the ACA.

KOWALSKI: I’ve said this publicly before and I’m saying it again — we are, at WPS, full steam ahead. We still have a company to run, and we still have members to support and serve. We’re looking at expanding some of our products outside of the state. It’s a very competitive state and no matter what happens legislatively, we’ve recognized that we probably have to expand our borders a little bit, so we’re looking at expanding some of our product lines outside of the state.

We also recognized about three or four years ago that as the ACA gets rolled out, a lot more employers are going to be looking at self-insurance, taking on a lot of this burden themselves, paying out of their medical claims themselves, with some level of reinsurance to protect against catastrophic claims. In the last 18 months, that’s been the most popular product for us as more and more small businesses explore that option. That was something that we foresaw four years ago. We’re going to continue to do that, regardless of any tweaks to the ACA.

We have also spent the last five years getting as lean as we can, squeezing as much out of our operations as possible. It’s an extremely competitive environment and if we can lower our costs of doing business under any circumstances, obviously we’ll be more competitive in the marketplace.

One thing the ACA has done in the past five years is it’s really brought payers and providers to the table together to talk. That had not been the case for the previous 30 years. So no matter what happens, those discussions have been extremely healthy and those will continue in the new world as we move from fee-for-service to more value-based care and design. So that’s full steam ahead for the next three to five years. We’ll be focusing on that regardless of what happens to the ACA.

BURCHILL: We’re also spending a lot of our focus and energy on becoming a more efficient health care system. While we’re certainly focused on providing a better product at a lower cost, we’re also focused on affordability, making sure that our product is affordable and transparent to the marketplace.

KOWALSKI: We’re designing our rate structure and our product design offerings for 2018 right now. So in what business are you doing that nine or 10 months before you’re getting ready to sell it? A lot of those discussions — what we’re going to develop for products, how are we going to price them, what we’re going to put in the marketplace — have to be done now. So we’re going to put stuff in. We’ve got to follow the law as it is right now. We’re putting all those rates and products in with what we know today. If that changes three weeks from now or at the end of the summer when we have a chance to tweak some of this, that’s going to put the whole six months we’ve spent of trying to get those products ready to go right on their ear.

We spent a lot of time trying to educate the population out there. We weren’t even trying to do any selling. We’re just doing baseline education just to help people understand it. Most consumers are not too worried about whether insurance companies are going to get a health insurance tax, or whether the 10 essential benefits are going to look exactly like they do right now because most of them are going to get it anyway. They are worried about two things, and they are very selfish about it because it’s very personal and it has to do with them and their family: Is my doctor in the network? And how much is it going to cost me? Everything else is window dressing. If we can keep trying to educate consumers along the way about what that’s going to be, that’s frankly all they care about. So all these little tweaks that are happening on a weekly basis, they’re not … they just want you to tell them about those two things for 2018 when the smoke clears.

BURCHILL: Mike talked about the price sensitivity of the exchange market, and the positive is that it’s pushing us, as health care systems, to be more transparent with our pricing and be able to educate the market on what things are going to cost. People will start to shop more as their different benefit plans allow them, but a lot of these ACA plans have pretty significant deductibles and out-of-pocket numbers to hit before their coverage even kicks in, particularly if you’re young and healthy, you’re invincible, and you’re going to buy the catastrophic plan. But then if I need the MRI, we’re going to have to get better as health systems in being able to let folks know what it’s actually going to cost them and be more transparent. That’s one of the good things about the ACA. It started there but that’s really starting to push us to use that data and to be more transparent with it.

WEBER: In all fairness, we could have done a better job and there are opportunities for us to improve the way we communicate. We talk in a lingo that nobody understands, we use terms that media people aren’t familiar with, and so what happened with the ACA is that it required insurance companies to be able to talk one-on-one with people versus going to a human resource person or a CFO, so that changed the way that we did that. That has been a powerful change for us.

The other thing that happened is when the ACA first came, and the exchange first happened, there was a lot of thought that people would just go online and buy things, and that’s the way they were going to shop. That we were going to make it like Amazon.com and be able to buy insurance that way. Now, there has been an increase in utilization of the online services, but what we found is the consultant is still an integral part of the decision process for the individuals. So we’ve seen the increase of agents and consultants in the marketplace who are advising consumers. They are advocates. So I’m John and I’ll bring Physicians Plus, WPS, Unity, and SSM or Dean to the table, and their objective is to sit down with that person. Now, more and more people are doing things online, but they still want that person to look at them and advise them on what to do. We’re seeing that stay in the marketplace.

(Continued)

Pricy considerations

VANDEN PLAS: In terms of price transparency, are you actually putting your prices for various services online or communicating that somehow to consumers?

BURCHILL: We’ve started to do some on the ambulatory side. We have a better idea and a better way of looking at some of our ambulatory services. We’re just in the beginning stages of that, but we’ve focused initially on some of the ambulatory stuff. Some of the imaging, lab, therapies — some of the things that…

KOWALSKI: Joints will be next. [Laughs]

BURCHILL: So we’re getting there. We’re taking small steps, but we’re focused on that initially to get our arms around it a little better, and then hopefully that will continue to move into the inpatient world.

WEBER: That’s a big demand because as Scott said about the self-funded products, and the fact that the marketplace — I say the marketplace but they are people — the people, the individuals, the families, they want to know that if they come to St. Mary’s, what is the cost? If they go to Meriter, what does it cost? If they go to UW, what does it cost? Now, there are still variables within that, but it’s a top priority for many organizations to make sure that’s there. It goes back to the data. People want to be able to make informed decisions.

We’re also being changed by other marketplaces. When we look at the industry, we always think that people frame us. It’s what’s WPS doing? Or what’s UnityPoint doing? Or what’s SSM Health doing? The reality is that it’s what’s Amazon doing? Or what is Marcus Theatres doing? What are people doing to improve the customer experience? That’s the criteria that we’re judged on now. The fact that when you go to a doctor’s visit and if your appointment is at noon, you should get in at noon. The days of well, you get there a half-hour early and then you stay a half-hour late, those are becoming a thing of the past. The expectation in the marketplace is really changing based on other industries, and I welcome that change.

“I see a lot of reports that over the next three to five years we’re going to double and triple the amount of drugs. It’s not just the cost of the drugs, it’s the sheer number of them.” — Scott Kowalski, WPS Health Insurance

KOWALSKI: Not to harp on it, transparency is fine, but it’s different than buying a movie ticket. If you go to Marcus and you buy your $8 movie ticket, it is what it is. If you look online for a hip replacement, and it’s $25,000 at this care system and it’s $30,000 at that care system, maybe your behavior will change. Maybe you will go for the cheaper one — it doesn’t always mean it’s the better quality just because it’s cheaper, but that isn’t the price. That isn’t going to end up being what comes out of your pocket.

People really are struggling and it’s so complicated to take that price and run it through whatever insurance plan you happen to be on. After you run through the deductibles and then the maximum out-of-pocket, and then whatever the health insurer negotiates with the provider, the consumer has no idea, once that blender gets done, what it’s going to kick out for a fee. So it’s $25,000 but at the end of the day, it’s going to cost me $1,800 out-of-pocket? Is it going to cost me $500 out-of-pocket? So the transparency on the provider side is only one thing. They’re all working toward getting to that point, but once you run that through your insurance coverage, it becomes a blender.

We talk a lot about individuals. Individual business is 12% to 15% of the market. The lion’s share of what we’re talking about is still people who are covered under their employer’s plan, and we are finding stress on the head of HR or the vice president of finance or whoever runs those shops. A lot of times, for a 37-person or an 87-person group, that person has six hats that they are wearing. The amount of regulatory burden that they are facing, both from legal and compliance, to educating their employees, is through the roof. That’s where I see it. I’m a big proponent of small business and I see the stress on a small business and the role of the agent to help with our co-client to educate these businesses on the implications for their employees. Like I said, 85% of the people who walk through the door are covered under a group plan provided by their employer, and the employer is dictating the terms for that individual to engage. It’s much easier when it’s an individual getting on the exchange. They control their own destiny. When you’re insured through your employer, the box has been defined for you.

BURCHILL: On price transparency, we’re actually doing that. When someone comes in, we start running him through his benefit. What I’m saying is that when you have your ambulatory surgery with us, with the way your benefit is designed, you’re going to pay us $750 because then whatever kicks in. That’s why we’re starting small with a pilot to focus on a subset because you’re right, the cost of health care, our charge, means absolutely nothing. Our cost is x-amount but then under your plan, it might cost you $1,000, or it might cost you $2,000. That’s the level we’re trying to get to; we’re actually getting to that with some procedures right now.

WEBER: That’s a check and balance because we have historically, in this marketplace, had amazing relationships with our primary care physicians. So if I go to Dr. Random in Waunakee, and he tells me to go to this place for an MRI, I am going to go to that place for an MRI because of my relationship with him, but it does provide some assurance for the person because they don’t really have to check it.

Cost control

VANDEN PLAS: How can employers, working with their insurers and their employees, control medical insurance costs no matter what health care system emerges from the present debate?

KOWALSKI: No matter what happens, we can all stand to take a little bit better care of ourselves, no question about it. Five percent of the population, at least in our insured population, 5% of our insured drive 50% of the cost. So they are frequent flyers, they are people that require a lot of care and heavy utilization, and they have multiple chronic conditions. They have a lot of challenges, and we can work with employers and with our provider partners to concentrate on just that 5%. Whether it’s diabetes or MS or Lou Gehrig’s or cancer, these are extremely challenging conditions. Under any circumstances, we can work more closely with our partners to address that population.

The other thing is the cost of prescription drugs. We’re seeing the cost of drugs is close to one-third of our overall costs. So one-third of all the expense that goes through our organization is related to drugs, roughly speaking. That’s a huge number. Over the last 10 or 15 years, we’ve convinced ourselves that a lot of our conditions can be handled with just more drugs. Drug adherence to a diabetic is extremely important, but what I see is a lot of over-prescription to folks. It’s causing a lot of long-term effects, and it’s putting a ton of cost into the system, and it’s only going to go higher. I see a lot of reports that over
the next three to five years we’re going to double and triple the amount of drugs. It’s not just the cost of the drugs, it’s the sheer number of them.

BURCHILL: A lot of the insured population is really that small to mid-sized employer, and one of the things employers could do, working with their employees, is to actually educate them just on health care benefits and how it impacts the sustainability of the business. You’re employed by a business and the single largest line item that your employer really doesn’t have a lot of control over is health care benefits, and most employees really don’t understand that. They historically haven’t shared in much of the cost of it, and so to them it’s, “Well, I pay my $250 per paycheck to cover my family and I’ve got some copays and deductibles,’ but I don’t know if they are educated to understand how it impacts the company they work for. Two, we talk about it all the time, but it’s just starting to participate in cost sharing and understand the decisions you make with your diet and other choices, how this all ties together, so education is a big piece of it.

Employers could do more and more cost sharing with their employees. It doesn’t have to be significant, but you have to start getting their heads in the game. I’d maybe ask Mike and Scott if they have seen much impact, but there was this big craze, and it seems as though it’s dying off a bit, around wellness and all these incentives and if you take this screening and you meet certain numbers, and you try to incent employees. I haven’t seen a lot of articles out there that say this is having a significant impact, but Mike and Scott might have different data, given that they are on the direct insurance side. I’m not sure the incentive piece has worked that well to date.

The last point would be with the employers and the insurers, hopefully the level of conversation continues to change over time. Just from some past roles I’ve had, you really just sit down and talk about price and hopefully those conversations continue to evolve between insurers and employers to try to be more innovative, to really focus on their employees that are the sickest. Insurers have really wanted to do that, but it really comes down to price. It really comes down to, what’s it going to cost me as an employer? We’ve talked about the hospitals, physicians, and insurance becoming more innovative with their models, and hopefully we can do the same by bringing the employers into that equation.

WEBER: That question is interesting. That question is not something that is a response to ACA. That is the $10,000 question where health care has to prove itself. Health care has to be efficient. What does that mean? The way that people can understand it is — we talk about the premiums — but people have an expectation of quality of care. People have an expectation of access. People have an expectation of wellbeing. I really believe it’s a forward-thinking solution now. It isn’t the days of ‘this is my population and what have we done?’ And now some people say risk, or cost sharing. A lot of people call it cost shifting. You’re basically putting more of the burden on the member, the patient. I’ll say that we’re at a point where the member and the patient can’t afford it anymore, so those levers are gone because it comes to a point where the wellness, the wellbeing, that’s important, but there is a certain amount of your population that will be covered, that will embrace that, whether it’s 20% or 30%. The reality is that each and every day health care providers in an integrated system — the hospital and the clinic and the health plan — work together. That’s very important.

The other thing that’s important and interesting is that when we go to employer groups, we will bring representatives from the hospital and the clinic, so sometimes physicians will go with us. So when they sit across from a business or a patient, and they say, ‘I can’t afford this,’ that’s a very powerful message to someone in care delivery. Just like it’s very powerful for us to sit across from someone when you’re at an employee meeting, and they pull you off to the side, and they’ve got tears in their eyes and they want to make sure their physician is in the network because of a serious illness for someone else.

(Continued)

KOWALSKI: The other way to do this is to look at something other than just the medical care. I’m not by any stretch of the imagination an expert on ‘pop health,’ but I do look at health outcomes data. About 20% of all the costs associated with taking care of people are on the medical side. We only have so many employees that work one-on-one with our members, so what we’re doing is establishing partnerships around the state with not-for-profits who are embedded in their communities, who know their population very well, and have trust, which most members don’t have with insurance companies or sometimes even large provider systems, and in some of these smaller towns where these not-for-profits are operating, they know the family doctor in that area. They know the primary care physicians that practice in that particular area, so they all know each other fairly well.

We’re doing a pilot right now where we are reaching out to maybe a half dozen to 10 of those entities around the state to find people where they are at and help them with their health behaviors, their physical environment, social and economic factors, transportation — all things that affect their health collectively much more than medical expenses. So the behavioral side — are they getting enough exercise? Are they getting enough access to healthy food? What did they go to these not-for-profits for? Did they need counseling there? Is there a mental health component?

So we’re bringing in this third or fourth party to help us with people, meeting them where they are at based on their socioeconomic environment. We’re starting that as a pilot and we’re going to expand that over the next three to five years and see where that leads us. Maybe we’ll get into working with churches and the Masons and the Rotarians, but just getting deep into these communities and finding people where they are at is a huge determinant of how healthy they are going to be.

“My biggest fear is that people stop being engaged because it’s too complicated.” — Mike Weber, Dean Health Plan

WEBER: The other thing that has changed in the marketplace is the way the employers look at their benefits. When I started many years ago, there was a conversation that just talked about health care, the health insurance benefit. Now, when employers look at their benefits, to Scott’s point about larger employers, it’s a holistic view of all the benefits they offer, so this is just one component of that. They literally will have a strategy on how they approach health care and the commitment to benefits. Again, it used to be that you’d have one conversation, and it was just about health insurance. Now if you go to a large employer around here, it’s a broad spectrum of things that they have to incorporate into that budget.

KOWALSKI: Kind of the total awards program. The term for me in the HR world, the total awards, is all of this stuff. How do we take our employees into this holistically? We might provide a great benefit on the health care side, but is there a transportation or access issue that we can help with? We’re a very large employer, as well, and we test a lot of this stuff on our employees. We have 2,200 employees right here in Madison and so a lot of our clients ask, ‘What are you doing with your own population?’ We need to be able, certainly if you’re on the sales side, to lead by example. You better have that figured out and, oh by the way, we want to do well by our employees, too, and make sure that we look at the entire spectrum, so we’ve uncovered a lot of things. Some people don’t have proper refrigeration. We have all kinds of employees. You don’t know why they are not adhering to their drugs. You don’t know why they are not getting to their age-level screening on time. You don’t know about all that stuff and without getting into too much personal health information, you want to be able to provide the full spectrum of benefits so you have all that stuff covered.

WEBER: And part of it is that as prices go up, value-based care becomes more important, and really what you try to do is determine whether there is an opportunity, when you are looking at things, to eliminate some barriers so people don’t have costs in certain areas of care. That is a hard question because every organization has been working hard to try to address that, and there is no silver bullet for that.

Concerning the AHCA

Vanden Plas: To wrap things up, what concerns you most about the revised repeal and replacement measure — the American Health Care Act — being considered in Congress?

BURCHILL: We don’t know exactly where it is headed. We have had ACA for a few years now, so we have some information and we have some data. It depends on what you believe, but I think we know a little bit about what’s working well and what isn’t working well. As I look at the Innovation Institute, the different programs and pilots that have come out, one of the things on the table is a significant cut to the innovation component of ACA. That’s one of the fears that I have because we need to try to continue to be innovative because these one-size-fits-all solutions just don’t seem to work. My biggest concern is that doesn’t get cut and that it actually gets more dollars behind it to help insurers and health systems and physician groups and hospitals, and potentially with employees, to sit down and create and test innovative ideas and pilots because it’s hard to do that in health care. While everybody talks about the transition from fee-for-service to value-based, most health systems and most physicians are still paid based
on fee-for-service.

WEBER: And they are wired that way.

BURCHILL: That’s how we’ve all been programmed and how we’re wired and how we’ve worked for years, and I really think we need innovative solutions at the local level in different communities, bringing in different community organizations and insurers and everybody together. If I had to pick one thing, let’s not cut that and let’s invest in that more, see what can happen at the local level, and learn from that.

KOWALSKI: Well, I have four fears. My first fear is that nothing will be passed. There was an effort right after they determined they won’t be able to get the votes in the House the first time around, right at the 11th hour, they put another $10 billion in there for state innovation. That wasn’t enough to bait the hook for the Freedom Caucus, so that innovation and that sort of getting activity generated at the state level, is still on the table so I think it’s going to show itself at some point. So my first fear is nothing will get passed, or it will make it through the House and it won’t make it through the Senate. I’m very worried that nothing comprehensive will happen.

The second things is, if it does get passed, I’m worried that it will be just as complicated and difficult to implement as the first go-around in 2010. It’s clear that there is no smooth path to repeal and replace, which means it’s going to have a lot of bumps if it does get approved in any way, shape, or form.

The third thing is that if it does go through, one of the things the previous administration discovered once they passed the bill into law was that there were a ton of rules and regulations that had to be promulgated for it to actually have any effect, and a lot of those rules and regulations were being made up on the fly and they were law. When those are declared, either by the IRS or by the Department of Health and Human Services, CMS, et cetera, we have to follow those rules and laws, and then four months later they change, or a different law that affects a different part of the ACA has to get initiated, so I’m worried that this administration will enter with the same naïveté as the previous one and say, ‘Okay, you new agencies, you figure out all the nuances to that.’ Those 300 meetings for us were on the internal side. What does that actually mean to us? We have big systems that have to adjust to respond to those rules and regulations.

My fourth point is that somewhere along the line the states will be forgotten again. It’s apparent that, certainly under this administration, and I don’t know how it might be diluted as it moves through Congress, but this administration’s position is that we’re going to put more of this on the shoulders of the states. There are states like Wisconsin that welcome that. We have a very diverse population. We have a ton of competition both on the delivery side and on the payer side. We have things that we were doing pretty well before the ACA. The ACA, one of its primary goals was to level the playing field and provide something to a bunch of states that didn’t have what one of these other states have. We bore a tremendous burden for that in the state of Wisconsin because we had a lot of things that were working well. We had a high-risk insurance pool. We were able to determine benefit designs at the state level.

I use the example of the 18-person employer that has 30 single guys turning a wrench in an auto repair shop. They probably don’t need maternity coverage, assuming they are not married. Why not allow benefits to be designed that are consistent with what an employer and an employee want? Why mandate that each and every plan have these 10 essential benefits? It makes no sense. Allow the states to determine that. So I’m excited about the thought of having a high-risk insurance pool back in Wisconsin, elevating again associations and co-ops and those sorts of buying consortiums to spread out risk. I’ve always liked that idea. Anything that can be pushed out to the states, the administration will be able to declare some sort of victory to say, ‘Listen, we did this. We enabled a lot of these laws to be implemented at the state level. Go talk to your state legislature and your OCI commissioner.’ I’m worried that somehow doesn’t happen. I’m very bullish on letting states determine what’s right for their populations in their unique circumstances.

WEBER: My biggest fear is that people stop being engaged because it’s too complicated. We’re at the tipping point of where you turn on the news and every single night you can read about whether it’s changing or whether it’s not changing. That’s a huge risk to employers, it’s a huge risk to members, and it’s a huge risk because what happens then is people stop being engaged because they assume that whatever decision is in today’s news. I heard a rumor last night that says it’s going to be voted on this week, and then all of the sudden I heard an hour later that well, they are leaving on Thursday so how could they possibly vote by Wednesday. And then you had someone who will sit there and just raise a hand and go, ‘You know, I just don’t understand it anymore.’ That’s a risk.

(Continued)

UnityPoint Health – Meriter

Three ways to beat stress at work 

Work-related stress can take its toll, both physically (insomnia, anxiety, tension) and emotionally (forgetfulness, moodiness, negativity). But most people don’t recognize the cause of those symptoms, according to Dr. Shelly Komondoros, an inpatient health psychologist at UnityPoint Health – Meriter.

“We are not socialized to understand that when we’re overstressed, our brain goes into fight-or-flight mode, or what’s called stress-response mode,” Komondoros says. “We just keep chugging along and staying the course. Rarely do people tie those symptoms to stress unless a doctor points it out.”

Once recognized, a doctor usually prescribes anti-anxiety medication, but the best long-term solution for beating stress, Komondoros suggests, is to get your mind and body in tune with each other. Here are three ways to do that:

1. Practice mindfulness: Mindfulness is keeping your mind in the present moment. “Anytime your mind is in the future or the past, it’s up to no good,” Komondoros says. “Mindfulness is being in tune with what your body is telling you. When our mind and body are in sync, stress-related symptoms become much easier to recognize and manage.”

She recommends two easy mindfulness approaches that can be followed throughout the workday. The first is “walking meditation”: Take a short walk to the restroom, around the office, or even outside, and focus exclusively on your feet touching the ground, the movement of your legs, and the surrounding environment — the texture of the walls or the greenness of the trees. The second approach involves sitting at your desk and finding a visual focal point: Breathe steadily and allow gravity to take over as your body relaxes for a few minutes.

2. Find and use a support system. A support system consists of a handful of people (spouse, sibling, significant other) who allow you to turn to them for insight and as a sounding board. Verbalizing stress allows you to vent anxiety and maybe even see issues from a new perspective.

“A really good support system involves people who leave you feeling restored and replenished,” Komondoros says.

3. Keep things in perspective. It’s easy to jump to conclusions when reports of a merger start circulating (“We’re all going to be fired! That’s what always happens!”) or you’re under so much pressure that you make sweeping generalizations (“I’ll never meet this deadline!”). “‘Always’ and ‘never’ are not true,” Komondoros says, referring to extreme generalities. “But when we say things like that, they become reality.” Turn to the previous two tips for some much-needed perspective to reframe your mindset. Think about other deadlines you’ve successfully met, and don’t worry about rumors or worst-case scenarios until they actually happen.

“With enough practice, these tips will become second nature and help you shut down stress,” Komondoros concludes.

– Mike Popke

View the full blog article at unitypoint.org/StressTips.

(Continued)

WPS Health Solutions

How do insurers evaluate new technologies?

New technology is introduced constantly to the medical field — including tests to uncover diseases, tools to treat injuries and chronic diseases, and apps to connect patients and providers — but it’s not a matter of buying
the shiniest new toy.

“Our job is to make sure premiums are going to pay for high-value care,” says Michael Ostrov, a family-medicine physician who also is Chief Medical Officer for WPS Health Solutions. “Employers want to know their healthcare companies are doing a rigorous job of assessing new technologies to make sure those technologies are not wasted costs.”

When deciding whether to cover a new technology or procedure, an insurance company must weigh two factors: First, its clinical utility must be determined. For example, does a test have the potential to change treatment decisions? Second, its cost-effectiveness must be compared to the best current approaches.

Genetic testing is sometimes used to evaluate for a suspected genetic condition and to help determine a person’s chance of developing or passing on a genetically related disorder. A few tests are well established, but many of them are considered “low-value care,” Ostrov says, because their effectiveness has not been proven. “In those cases, it’s a wasted health care cost.”

The Institute of Medicine has determined that about 30 cents of every health care dollar is wasted on unnecessary services, fraud, and other problems.

That said, how does WPS determine which new technologies or procedures won’t lead to wasted costs and should be covered? The company subscribes to reports from national and international technology assessment companies that use a medically based, evidence-grading evaluation process. This approach has improved dramatically in recent years, according to Ostrov.

“We also review the medical policies of the largest national insurers who do their own medical policy development,” he adds. “We use a combination of these nationally vetted policies and our own medical policies to best meet the needs of all our members.”

At a minimum, new technologies undergo annual evaluation by WPS experts. However, market demands sometimes call for an immediate appraisal of a technology, such as when Cologuard — the first and only FDA-approved stool DNA noninvasive colon cancer screening test, developed by Madison-based Exact Sciences — hit the market. (WPS includes coverage for Cologuard testing.)

“Medical care is already expensive, which is why employers don’t want their health insurance providers spending money on something that is unproven,” Ostrov says, suggesting that employers evaluating providers ask about a company’s technology assessment process.

“We take seriously our responsibility to be wise stewards of limited resources,” he concludes. “Through our careful process of evaluating new technologies, we’re able to cover leading-edge, proven therapies and avoid harmful ones. It’s important we protect individuals who trust us with their care.”

– Mike Popke

Find more at WPSHealthSolutions.com.

(Continued)

Dean Health Plan

How to have a healthy and productive workday

The small and consistent actions people make daily to improve their lives accumulate and lead to better health. Lisa Elsinger, manager of health promotion at Dean Health Plan, offers these five suggestions to help make the most of your workday.

1. Stand up: Studies link sitting for long periods of time to increased risk of heart disease, diabetes, and metabolic syndrome. “A major concern with prolonged sitting is musculoskeletal disorders caused by using incorrect posture,” Elsinger says. “When we sit at our desks, we often slouch — especially if the workstation is not set up to enable correct alignment. Slouching creates muscle tension and fatigue. Over a relatively short period of time, neck, shoulder, and back pain can become chronic and affect every aspect of people’s lives.”

If you sit a lot, set reminder prompts to take a 30-second break every 30 minutes. Stand up, stretch, look away from the computer screen, and breathe deeply a few times. Then, every hour or two, stand up and walk around for a few minutes, stretching your shoulders and hips. Also, consider doing a strengthening exercise with resistance bands. Even 10 repetitions for each major muscle group, done periodically during the workweek, can lead to significant improvement in posture and energy.

2. Eat breakfast: Job-related benefits of eating healthfully include reduced fatigue, improved mood, and a greater ability to concentrate. Breakfast is important, though it doesn’t necessarily need to be eaten early in the morning. “Do eat at some point during the morning, preferably food that contains protein and does not contain added sugar,” Elsinger says. “The typical coffee and sweet roll breakfast wreaks havoc
on the digestive system.”

She suggests eggs (use grapeseed oil for added flavor and health value), multigrain cereal, and fruit, nuts, or Greek yogurt. “The most important point about eating for energy is to avoid both over- and under-eating,” she adds. “Also, eating heavy, fried foods for breakfast or lunch leads to daytime fatigue.

3. Get at least seven hours of sleep: Many people are chronically sleep-deprived, according to Elsinger, which affects the ability to handle stress and to think and communicate clearly. It also increases the risk of
errors and accidents.

4. Stay hydrated: Not drinking enough water can have some of the same effects as lack of sleep, as well as lead to poor digestion, dizziness, and headaches. Stay away from sugary and sugar-free soft drinks, too, Elsinger suggests.

5. Work as a team:
While nutrition and physical activity are essential components of a healthy workplace, the most important factor influencing employee health is an organizational culture that supports employees’ healthy behaviors and habits. A workplace wellness program will only succeed if there is support and promotion at all levels within an organization.

– Mike Popke

Dean Health Plan believes that with the right tools, information and motivation, you can achieve your goals for a healthier lifestyle. That’s what our Living Healthy Program – powered by WebMD – is all about. Plus, you’ll earn rewards along the way! Visit deancare.com/livinghealthy to learn more.

(Continued)

Integration stands the test of time

Outside of Madison, health organizations search for dance partners.

When the Affordable Care Act was passed in 2010, area health care executives held the firm conviction that Greater Madison’s integrated approach to health care was well aligned with the new law.

Seven years later, just days before the House of Representatives voted for a partial repeal and replacement measure, their conviction hasn’t wavered. In fact, they remain convinced the integrated model of care, where hospitals, clinics, insurers, and other providers work together as part of the same health system, is the right model going forward regardless of what health care system the federal government puts in place.

Part of the proof is the wave of consolidation taking place elsewhere in Wisconsin and the nation. Scott Kowalski, executive vice president of WPS Health Insurance, notes the integrated care model is what the rest of the market is scrambling to establish.

“Payers and providers are talking and forming joint ventures like we have with Aspirus Arise up north,” he states. “You look at Aurora, Blue Cross-Blue Shield, and Anthem working together in Milwaukee to create a separate joint venture. You see risk sharing and payment reform discussions happening all over the state with all the payers and providers.

“The rest of the market is scrambling to see who their dance partners will be so they can get to that model.”

While integrated care systems face the same challenge of controlling costs as other models, one of their purported benefits is they are more accommodating to innovation. Todd Burchill, vice president of business development for UnityPoint Health-Meriter, believes the integrated model provides the opportunity to be more innovative in terms of how systems approach their communities and patients. “We’ve got the financing piece and the care-delivery piece,” he notes. “When you have an arms-length relationship with an insurance company, all of your incentives aren’t necessarily aligned.”

Much of the consolidation in health care, Burchill adds, is being spurred by the fact that integrated delivery networks are enabling and pushing other payers to be more innovative with their delivery system partners. “That ultimately will be good for everybody,” he states. “It really allows us to align the economics and the care delivery and the clinical piece together, and that’s what we really need to move toward — being able to share with each other in that model.”

Mike Weber, executive director of sales and client services for Dean Health Plan, observes that local integrated care systems are collaborative but yet they compete, which creates a differentiation challenge. “When we’re looking at all those things, we can say that we’re value-based, we can say that we take care of the patient, and we can say that we take care of the member, but the reality is how do you differentiate that experience if you’re in a market in which 90% of the people are covered that way?” he asks.

Even with that, Weber touts the collaborative importance of an integrated system. “We have a unique situation where we are the hospital, the clinic, and the health plan, and we are sitting in the same room having conversations to see how it affects patient care, access, and affordability, and that’s been leveraged very strongly lately,” he states. “Historically, sometimes we came from different views, and now we sit in a room and we have those conversations about how we can be more efficient and move forward.”

In addition to cost control, one thing integrated-care networks still grapple with is the sharing of patient and medical claims data, Kowalski notes, adding that it can be a challenge even with most local health systems using Epic’s electronic medical record software. “We didn’t realize that Epic could be set up so many different ways,” he states. “They don’t even have a consistent storing of the data or categorizing of the data on their side, so imagine what happens when we’re trying to share claims data. That’s the ultimate. When we have the claims data and the system has the patient information, and we bring those two together, that’s when we can really affect patient health, but that is hard to do.

“I talk to my friends on the integrated side and I say, ‘Don’t worry. We’re part of the system, and we still don’t have that figured out.’ So you can imagine when you’re an independent trying to do that with systems, multiple systems. It is a challenge.”

Weber cited another data challenge that is related to the high qualitative expectations of the Madison health care market. “I’ve been at Dean for 19 years,” he states, “and I remember that when I used to go to employer groups, I would show all the claims data. We would sit down and we would have all these fancy reports and we would show everything that happened during the last two years. Well, people have changed. People want to know what’s going to happen in the next 12 months, the next 36 months, with their population.

“They don’t want a rear-view mirror approach to health care, they want to look forward and say, ‘What is your best estimate?’”

— Joe Vanden Plas

(Continued)

SPONSORED CONTENT

Small businesses turn dire prediction on its head

Massive employee dumping did not happen.

Many predictions were made when the Affordable Care Act was signed into law, but among the ones that did not pan out was that small employer groups were going to go away because the vast majority of small business owners would simply “dump” their employees onto the Obamacare health exchanges.

As is often the case with predictions that are offered with such certitude, that did not happen to the degree that was forecast. Many small businesses remain on their pre-ACA plans for a very fundamental reason — they must hang onto their workers in an era of labor shortages and intense competition for labor.

Mike Weber, executive director of sales and client services for Dean Health Plan, says in the Madison market it’s probably a 50-50 split, but outside of Madison upwards of 90% of small employers are still on their pre-ACA plans. “What we’re seeing right now is the small employers re-engaging, that they are getting plans for their employees,” he states.

According to Scott Kowalski, executive vice president for WPS Health Insurance, a lot of people were surprised that small business not would use this as an opportunity to eliminate their plans. “I’ve got a newfound appreciation for small business in this state,” he states. “It appears to me that even though it’s the second highest line item on their budget after their payroll, they really, really look for ways to insure their employees. It is a competitive advantage for them, it builds loyalty, it seems to be in the DNA of the small business, but that shocked me.”

Weber was not as shocked because of his background in the hospitality business prior to joining Dean. He ran a restaurant and he knows what it’s like to make payroll with your credit card. “You’ve got to hold onto people,” he states. “It is a personal relationship with a small businessperson. The first time a small businessperson can offer benefits to his employees, it’s a proud moment.”

Looming deadline?

Looking ahead, Kowalski worries that a lot of small businesses — which the ACA defines as anyone under 50 employees — will still have non ACA-compliant plans that have been temporarily grandfathered in, but while that deadline has been extended to run out at the end of 2018, there is no guarantee of another extension.

The repeal and replacement of the ACA would make that question moot, but it’s still the law of the land, that deadline still looms, and many of these grandfathered plans haven’t been dissected or analyzed. “Let’s fast forward to 18 months from now,” Kowalski says. “I think it’s going to be a bit of a feeding frenzy at the end of next year, where all of these small groups are saying, ‘Oh gosh, we’ve got to get on an ACA-compliant plan. We’re not on a plan that’s legal anymore.’ The grandfathered period has run out, and it’s going to be a feeding frenzy. Everybody’s groups are going to be out looking around for different quotes. That’s when they’ll really start looking at self-insurance.”

Weber notes that the deadline has been moved back more than once, but that could offer a false sense of security. “If I’m a small businessperson, I’m thinking you told me it’s going to change and it hasn’t for three years in a row, so what makes me believe — again, forward thinking — what makes me believe, unless there is some political change, that it’s going to happen?”

Todd Burchill, vice president of business development for UnityPoint Health-Meriter, says one dangerous result of apathy is a lack of planning. “They are starting to get apathetic, and they are tired of listening to it,” he states. “The concern I would have is that they tune out and all of the sudden things actually do change. Hopefully, some of these small employers and others are at least starting to scenario plan or contingency plan just to have different options on the table because at some point the switch might flip.”

Click here to sign up for the free IB ezine — your twice-weekly resource for local business news, analysis, voices, and the names you need to know. If you are not already a subscriber to In Business magazine, be sure to sign up for our monthly print edition here.