Health insurers are aggressively marketing high-deductible
insurance plans that allow patients to reduce their out-of-pocket costs by
improving their health. But employers, concerned with legal issues and upsetting
employees, have largely stayed away.
A prolonged recession could change that, consultants and
health insurers say.
“I think a long, deep recession will accelerate” the adoption
of these plans, said Tom Beauregard, who leads product development for
UnitedHealthcare, which launched its Vital Measures plan last year. “This is the
next frontier for how we manage costs because you’re not going to do it through
increased cost sharing.”
Adopting these plans will mean employers will have to embrace
a notion that consumers, according to internal research by UnitedHealth, have
been more willing to accept that people who lead unhealthy lifestyles should pay
more for their health care.
“The life insurance industry has done it for years for
smokers,” said Chris Riedl, a senior manager at Aetna. "The same is true with home insurance. If you
choose to live close to a fire department, you have lower fire premiums and that
makes sense.”
Employees would still have access to care and catastrophic
coverage. A deductible, however, would decrease if a person improved or
maintained good health.
Until now, most health plans and employers have rewarded
employees for participating in wellness programs rather than achieving good
health in four areas: weight, not smoking, cholesterol and blood
pressure.
Employers are increasingly recognizing the connection between
a person’s lifestyle and their health care costs. More are willing to offer
monetary incentives for employees to participate in wellness programs. Few,
however, have tied incentives to employees’ ability to be
healthier.
A typical program is designed to work with a high deductible.
If a deductible is $1,500, for example, an employer could offer four
opportunities for an employee to earn a total of $1,000 off his or her
deductible. Doug Short, president of Benicomp, the Fort Wayne, Indiana-based
firm that designed the payment system for these plans, said the plan is a
cost-efficient way to introduce incentives to employees.
“It’s not additional money on top of the health plan cost,”
Short said. “It’s managing cost shifting within [a] health
program.”
As long as the health measures such as cholesterol and blood
pressure are used, the plan is considered to be legal by the Internal Revenue
Service, which regulates wellness programs. Those measures are considered the
result of lifestyle choices unlike health conditions, which are a matter of bad
luck, said Susan Relland, an attorney with law firm Miller & Chevalier in
Washington.
The incentives must add up to less than 20 percent of the plan’s total cost.
That generally means a plan that costs $5,000 cannot have more than $1,000 worth
of incentives.
So far, only a few companies have implemented health care and
employment policies based on a person’s health.
“I do think there is some hesitancy to go down the path of
health outcomes,” Riedl said. “It’s a controversial topic.”
Clarion Health in Indianapolis halted its wellness program after
a plan to tie insurance costs to health outcomes angered
employees.
Employers should spend time educating employees about the
relationship between health care costs and lifestyle choices, Riedl
said.
“You have to be mindful of how your employee population will
react,” Riedl said. “It’s important to design a program that aligns with a
company’s corporate culture.”
—Jeremy Smerd
Workforce
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