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Actions that make a positive difference in health insurance costs – one employer’s story

Don’t you wish there was a magic formula for staying healthy and saving money on health insurance costs? Unfortunately, there isn’t.

But would you be surprised to hear there are things employers can do, in collaboration with their insurance provider, to contribute to better employee health and save money – $60,000, for example?

That’s just what Prevention Genetics in Marshfield, Wis. has done with its insurance partner, Security Health Plan.

A few years ago Prevention Genetics had an unfavorable medical-loss ratio, or MLR. That’s the percentage of insurance premiums spent on claims and expenses that improve health care quality.

Prevention Genetics works with Ansay & Associates as their benefit consultants. Ansay & Associates Executive Vice President Pete Valiska said he has been impressed with how Security Health Plan and Prevention Genetics have worked together to address the MLR issue.

“Price is important for everyone when it comes to buying health insurance, but it’s not always necessarily the bottom line,” Valiska said. “Prevention Genetics doesn’t see this as just a transactional relationship, the way a lot of people see their health insurance carrier. That relationship allows a long-term plan to grow and actually reap benefits.”

Security Health Plan worked with Prevention Genetics to establish an agreement by which, if Prevention Genetics were able to lower their anticipated medical claims expenses over time, the Health Plan would be able to refund part of their premium dollars.

And due to the tangible changes Prevention Genetics made, this summer Security Health Plan was able to present the company with a $60,000 check that leadership shared with all 215 of their employees.
Prevention Genetics Human Resources Manager Jessica Olson said the improvements that led to the refund were possible because of the longstanding relationship between employer and insurance provider. It took a commitment by Security Health Plan to work with Prevention Genetics and educate everyone at the company about the programs and services that, over time, can make a difference.

“My partnership with Security has been extremely helpful,” Olson said. “I’m able to say ‘OK, walk me through this right now’ and Security does – this has been a true partnership that has just gone full circle,” she said. “If you aren’t an employer that is willing to work to understand all of these pieces, you’re not going to be able to provide that to your employees. That’s a key thing, that partnership with Security.”

Valiska agrees that the leadership at Prevention Genetics has been smart to invest for long-term benefits, and they are extremely committed to doing what’s best for their employees.

“They obviously want to offer really good benefits, which they do through Security,” he said. “Most carriers don’t put the resources into the programs that make a plan run better over time. All those extra programs are really what make the engine go.”

Partnering closely with employer groups is how Security Health Plan does business.

“We truly want the best health and financial outcomes for our employers and their employees,” said Security Health Plan Director of Sales Kara Johnson. “Our goal is to do things differently than the large national carriers – everything from 100% coverage for Care My Way virtual visits, and increased levels of diabetes coverage to keep high cost claims down – is intended to do that.”
Olson said providing high-value programs helps their employees reach their best health and prevent higher cost claims in the long-term. Here are the programs and tactics that worked for them.

1 – Educate employees to be smart health care consumers
In 2019, Prevention Genetics switched to a more formal education process during health insurance open enrollment season. Meetings used to be informal open-houses where employees picked up a packet of information and took it home. The company switched things up and invited Security Health Plan representatives to attend the meetings and answer employee questions while they looked through the offerings for that year.

“Health insurance is confusing even for those who work in it every day,” Olson said. “I’m a big proponent of educating employees about health care utilization across the board.”

That includes educating about the right questions to ask in the entire health care space, not just in the realm of insurance.

“Let’s be smart consumers; ask the doctors why they’re ordering a certain lab or procedure, or talk to the doctor about the proper medication,” Olson said. “Take the initiative to ask about how much it will cost and how to find the best pricing for them and their families. We’re trying to let our employees know they have rights, and they have the right to ask questions of providers and insurance companies.”

The open enrollment meetings are the perfect venue where employees have access to Security Health Plan representatives. During heightened periods of the pandemic, they pulled back on in-person meetings but still met virtually.

“They’ve felt comfortable enough to where they can pull somebody aside, asks those questions and somebody will sit down with them and have that one-on-one,” Olson said.

“We are here to help employees understand their benefits and how to use them to their advantage,” Johnson said. “We are onsite and available to support HR and their benefit consultants in helping to prevent surprises for employees.”

2 – Make smart plan design choices
Prevention Genetics added the SimplyOne plan with enhanced primary care benefits at their last renewal, which has enforced the message to employees that establishing a primary care provider (PCP) and getting regular preventive care each year is important.

“Part of the education is explaining to people that they should go in and get that preventive care so it doesn’t come around and bite you somewhere down the road,” Olson said. “To not go in for preventive care could result in bigger issues that are going to impact your health, your insurance and impact you financially.”

Another big plan design update was coinsurance for emergency room visits. This was a large part of Prevention Genetics’ education process for their employees as well.

“Consumers don’t understand what going to the ER with non-ER situations can do to your bill,” Olson said. “You should be scheduling appointments with your primary care provider or going into urgent care, rather than going to the ER.”

3 – Implement virtual care at the work site with Care My Way @ Work
“Another service we implemented was Care My Way @ Work – that was a huge benefit to our employees that we’d like to increase the use of,” Olson said.

Care My Way @ Work is a virtual appointment with a Marshfield Clinic Health System nurse practitioner in a private location at the work site that is free for Security Health Plan members. The Care My Way @ Work device and an iPad walk employees through instructions to collect exam data, which is sent to the nurse practitioner, and then employees connect via video chat with them. Employees can visit Care My Way @ Work during breaks or at lunch, rather than taking time off for an off -site doctor’s visit, minimizing downtime and employee absences.

“We took an office and put the equipment in there, told the employees what the Care My Way hours are, and we hope with continued communication they’ll keep using it,” Olson said. “Our employees are happy they have that choice, to go in there instead of having to interrupt their day and run into the clinic when it can just be a quick conversation.”

4 – Changed the wellness program to be more all-encompassing
Prevention Genetics has always had a very health-conscious culture overall, Olson said.

“We take a whole-person approach when it comes to our wellness program, so we look at three components: fitness, mental health and nutrition.”

They have a wellness committee that offers challenges or seminars every month depending on what the committee has decided to focus on.

All of these programs and services are not a magic cure for anything, but over time, Olson said, people start to notice improvements, and that encourages them to keep at it.

“This is a process that takes place – the momentum starts and we have to keep that momentum going,” she said. “You take these baby steps, and keep doing the communication.”

Olson said it was incredibly rewarding to be able to present the refund back to their employees. She said Prevention Genetics leadership shared the news in the employee newsletter.

“We told them, ‘Here is the result of all our efforts, and congratulations to you guys – part of this money is going to go back to you in your paycheck,’” Olson said. “Some of them came up and said, ‘Wow, I get it now!’”

For more information about employer group insurance coverage from Security Health Plan, please visit the website at www.securityhealth.org or contact the market development team at 1-800-622-7790.