The Relevancy Of Value Based Care For Your Employee

Imagine your health benefits being far more than a growing line item on your annual budget that you seem to control. Imagine your health plan being a partner in the well-being of your workforce, providing the peace of mind and coordinated care that employees need to be their healthiest, most productive selves at work. That’s value-based care. Centres of excellence are becoming the next big thing in health care coverage, as employers seek to control costs while improving employee health outcomes.

Value-Based Health Care

Value-based health benefit design is a holistic, consumer-centered approach that focuses not on the actual dollars being spent but on how the dollars being spent work to improve employee’s health. Healthier and more productive employees result in a better return on health care investment, positively impacting a business bottom line.

The first step is to create a culture of health within a company, a positive environment that supports and encourages physical, emotional and financial health among employees. Healthy, satisfied employees are valuable assets, and successful companies offer them the means to attain an enhanced quality of life. Senior management must champion the cause and be active participants in the endeavour.

Employee Education and Involvement

With this type of value-based system, the employer provides educational resources and tools combined with health improvement programs such as disease and case management and wellness programs. The goal is to help healthy individuals maintain, at-risk individuals improve, and ill individuals manage their health.

Employees are encouraged to become the primary person responsible for their own health. Through education, support and tools, medical billing and coding, they understand their diagnosis and course of treatment. They become part of their medical team and participate in decision making. They are aware of the costs of services and are encouraged to choose high-quality care. Employers can help by providing nurse advice lines, a case manager or a health coach to assist employees on their medical journey.

Focusing on chronic conditions such as diabetes, asthma, hypertension and high cholesterol, the city of Ashville, NC, implemented a value-based initiative in 1996. Employees with these conditions received intensive education and were teamed with pharmacists to ensure prescription compliance and improve health outcomes. while the city saw an increase in claims costs for prescription drugs, an analysis of the diabetes care program showed a decrease in mean per patient per year prescription and insurance claims costs, from $7,082 before program implementation to $4,651 in the fifth year. On average, the number of sick days taken per patient per year decreased from 12.6 to six.

High-Quality Care Providers

Access to high-quality medical services and providers is imperative in a value-based healthcare model. Evidence-based medicine benefits identify the best course of treatment for a diagnosis. Individuals are encouraged to make use of services with high clinical value. Health coaches and case managers can guide patients to high-quality providers. Employers may offer incentives for their workers to visit health providers with a history of positive outcomes. For example, supermarket chain Hannaford urges employees to seek care at hospitals determined to be centres of excellence by offering a reduced or eliminated copayment.

United Food and Commercial Workers Local in Chicago provides a medical centre and pharmacy for its members and their families. Members receive a wide array of medical and dental services, including access to primary care physicians and specialists, lab and diagnostic services and therapies. a managed care department assists members needing further testing or hospitalisation. The centre negotiates directly with area hospitals. Members choosing one of these hospitals have 100 percent of the bill paid by the plan. Designed to provide easy access to quality health care professionals, the centre maintains both the health and productivity of members while being cost-effective for employers.

Data Driven

Value-based medicine begins by using data and technology to identify employees with establishes or newly diagnosed chronic conditions or those at high risk to develop such conditions. data and technology are also used to identify chronic conditions that are costly or responsible for productivity problems. specifically, employers and health plans are analysing health and prescription claims as well as short-term and long-term disability, worker’s compensation and absenteeism rates to identify high-cost conditions and employees. This data mining also reveals efficiencies and problems in the plan’s design, providers’ clinical outcomes and gaps in individuals’ treatments.

Changing the structure of the health-care system alone will not change the health care cost and delivery problems facing the world. health benefit plan design change initiatives are necessary, especially initiatives that focus on achieving and maintaining employee health and enhanced quality of life. as this financial crisis drives shrinking workforces, employee well-being and productivity are more important than ever. Preventive care and effective medical therapies lead to declining rates of illness, absenteeism, and presenteeism. Tough economic times require efficient and positive health spending.