Group likes risk, wellness programs
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If employers are to provide broad access to quality health care at a reasonable cost, they need to more aggressively engage workers in wellness and risk assessment programs, and raise employee awareness of what health care really costs.
That was the message from representatives of four major health plans Tuesday at the ninth annual Executive Leadership Forum sponsored by the Pittsburgh Business Group on Health, held at the Marriott Pittsburgh City Center, Downtown.
The sentiment echoed previous discussions on the same topic. The difference this time is that their words carried a heightened urgency.
"We know we're on an unsustainable trend," said Diane Holder, president and CEO of UPMC Health Plan.
To underscore the importance of the topic, PBGH executive director Christine Whipple opened Tuesday's session by noting that when the business group formed 30 years ago, health care costs represented 10 percent of America's gross domestic product. Today, it's about 16 percent, with costs exceeding $2.3 trillion annually.
"It's time for employers to move much more aggressively to ask employees to do things they need to do" to either get healthy or stay healthy, said Brian McGarry, head of Pennsylvania operations for Aetna.
Panelists suggested everything from health risk assessments for every new hire, to including employee health data during employee meetings on the company's financial results, to changing the very culture of the company to encourage, if not require, more attention to employee health.
Workers also should take on a greater share of the costs, the panelists agreed.
"People need to have skin in the game," said David Fields, executive director in Western Pennsylvania for HealthAmerica, so they are more aware of what their health care really costs and how that impacts the premiums.
"What they do collectively and what they do individually makes a big difference in their health care costs," said Mr. McGarry.
The final shape that health care reform will take remains unclear, with a key component -- the mandate that everyone carry health insurance to ensure that the risk is spread across both the healthy and the unwell -- was brought into question this week. President Barack Obama said he supported the states' right to seek waivers if they come up with their own plans that would cover the same number of people.
Reimbursement rates for government-run programs such as Medicare and Medicaid will be critical for this region, said Dan O'Malley, regional market president for insurer Highmark, because 50 to 60 percent of hospital patients here are on Medicare and another 15 percent are eligible for Medicaid.
With hospitals operating, on average, with 4 to 5 percent margins, physicians and hospitals are "significantly challenged," he said.
"There have to be changes in reimbursement."
First Published March 2, 2011 12:00 am
