As you probably know, health care reform continues to unfold since the bill was signed into law back in March of 2010.  2011 was a busy year for PPACA (Patient Protection and Affordability Care Act).  More of the provisions were rolled out, there were some deletions and a few of postponements.  The linked Benefits Buzz for January gives a concise review of the developments from 2011.  I hope this helps.

One area that could see a significant change is the Community Living Assistance Services and Supports (CLASS) Program.  According to an AP article, last Friday, Health and Human Services Secretary Kathleen Sebelius said the administration would not proceed with the plan because she has been unable to find a way to make the program financially solvent.  Though the Congressional Budget Office (CBO) cleared the way for a repeal, the White House administration rejected that step.  According to Kathleen Sebelius, they were unable to find a way to fund the program so that it would remain viable without tax payer bailout. “Despite our best analytical efforts, I do not see a viable path forward for CLASS implementation at this time,”  Sebelius said in a letter to congressional leaders.

This admission, coupled with the individual mandate challenges is starting to reveal some major chinks in the health care reform armour.  It will be interesting to see how this plays out over time.  Stay tuned.

However, when it comes to the flu, the question many of us ask is…should I get a flu shot?  The vast majority of medical professionals agree…the answer is YES.  There are many misconceptions about flu shots; will they give you the flu, I am healthy and don’t need one, I don’t have the time or the flu is not that bad.  The newsletter “Seasonal Flu Vaccine: Common Myths Exposed” will address many of these misconceptions and hopefully provide clarity on whether you should get a flu shot or not.  I got mine…I hope you do as well.

Til next time…

Have a great weekend.

“The total economic cost of overweight and obesity in the United States is $270 billion per year while the cost in Canada is about $30 billion a year, a new study shows.

The $300 billion total cost in the United States and Canada is the result of: increased need for medical care ($127 billion); loss of worker productivity due to higher rates of death ($49 billion); loss of productivity due to disability of active workers ($43 billion); and loss of productivity due to total disability ($72 billion), said the Society of Actuaries (SOA).”

But how much is obesity costing your company?  The Center for Disease Control (CDC) has developed an Obesity Cost Calculator.  The calculator estimates the costs of obesity based on characteristics of your company. These characteristics include costs for medical expenditures and the dollar value of increased absenteeism resulting from obesity. Costs are estimated separately based on body mass index (BMI).   To learn more about what the calculator can provide you, click on Obesity Calculator Article.  If you would like to access the calculator, click on CDC Obesity Cost Calculator.

I hope this helps.

• Read through benefit booklets to make sure that you have a thorough understanding of your benefits.  The worst time to learn about your benefits is when you need to receive services.  If you are diagnosed with a disease, the last thing you need is to be confused about how your insurance company is going to treat you.  
• Use resources like WebMD to research your conditions prior to talking to your doctor.  This will help give some basic foundation in the condition you will be treated for.  Additionally, this will help you to develop specific questions that you can ask your doctor the next time that you meet with them.
• Don’t be afraid to challenge your doctor and ask plenty of questions.  Doctors will often prescribe a course of treatment that includes multiple repeat procedures.  This happened to me recently.  I had a very successful surgery on my foot.  Each time I went in for a follow-up visit, the doctor would send me for an x-ray of the foot.  By the third time, I asked if the x-ray was really necessary.  My foot was feeling better each time I went in and was not crazy about exposing myself to additional radiation.  The doctor told me that this was the standard of practice.  I asked if it would hurt me to not have the x-ray and he said no.  If I had not asked the question, I would have continued to have the x-rays.  After asking the question and discussing it with the doctor,  I could make an educated decision on how I wanted to proceed.  

These are just a few suggestions.  You can also get more information on things you can do to become a better consumer the linked informational piece titled “Resources to compare health care costs”.  I hope this gives you a little insight into being a better health care consumer.  Please contact me with any questions.

As a benefits advisor, I have assisted companies with the evaluation, vendor selection and implementation of onsite health care solutions at their companies.  I have also worked for a business that provided with onsite health clinics and corporate wellness programs for larger businesses.   What I can tell you is that a well structured onsite health care clinic can provide companies with a significant savings in their health care spend.  They do this in a couple of ways.  First, most programs are designed on a fixed cost, or capitated basis.  This means that regardless of how many patients they see, the rate (hourly, daily, monthly, etc..)  is the same.  Depending on the onsite provider, medical supplies may also be included in the fixed rate. 

Another way in which a company can save money is on lost production time.  Usually an employer will lose about 1.5 – 2 hours of production time just for travel.  This, in addition to the actual time for the appointment could equate to 4 or more hours of lost production.  By having a clinician onsite, the travel time is eliminated.  Employees stop in, receive their care, and return to work in a fraction of the time. 

These are just two of the many benefits of onsite clinics.  Unfortunately, onsite clinics are not for everyone.  There are costs associated with establishing and running the clinic that are cost prohibitive for many employers under 500 lives.  However, there may be alternatives.  Please contact me to learn more about how an onsite clinic might work for you.

This is a big problem that we all need to take personal responsibility for.  However, there are a few simple things that employers can do to help.  The following article Wellness Initiatives to Promote Healthy Weight will help define some low or no-cost things that employers can do to help their employees manage the battle of the bulge.  Now, let’s all go for a walk!

• To expand public awareness of the growing likelihood of disability occurring among the working population;
• To increase public knowledge about the financial hardship that disability can have on wage earners and their families;
• To demonstrate the value of planning responsibly in the event disability prevents one from earning a living.

Their website is www.disabilitycanhappen.org.  I have picked just a few statistics that they presented that opened my eyes. 

1. 1 in 3 Americans will experience a long-term disability during their working lifetime. 
2. 70% of employees in the private sector are not covered by any type of private long-term disability insurance
3. 71% of people surveyed believed that serious accidents were the number one cause of disability.  This can help explain why so many people do not have coverage today (injuries always happen to someone else).  The truth is that only 9% of disabilities are caused by injuries.  91% are caused by illnesses. 

When you combine just these few stats, I think you will see that their is a huge need for some level of disability for all working adults.  Please let me know if I can answer any questions or if you would like to know more. 

Communication can’t be once a year; it must be strategic, ongoing and bite sized or manageable for the employees.  Employee benefit statements should be an integral part of this program.  They provide your employee a “big picture” view of their total compensation, not just what they are getting paid.  This will help them get a perspective on the true cost which will help them in the value equation.  Couple this with focused benefit design communication and monthly health and wellness information and you will find your employees better understanding and appreciating the benefits you provide. 

But when do you, as a business owner, have time to do all of this?  You don’t.  Your job is to keep your business running.  You need to find competent service providers that can remove this burden from you.  At Tailor Made Benefit Solutions, our motto is to provide service beyond the numbers.  This includes ongoing employee communication support for wellness and plan design as well as periodic employee benefit statements to help the employees to see the bigger picture.  Please let me know if we can help.

Voluntary benefits can be of great value to your employees if communicated properly.  The linked article Educating Employees on Voluntary Benefits reviews how valuable these programs can be.  It also discusses how important proper communication of these benefits is.  Please let me know if you would like to learn more. 

• 50 enrolled employees x $12,000 average cost per employee (singles and families combined) = $600,000 in annual health plan costs. 
• Annual health care trend increases of 12% x $600,000 in annual costs = $72,000 in new costs. 

Just think what a difference eliminating $72,000 in new costs would mean to a 50 life business.   In addition to this, it is well documented that for every dollar of direct medical savings a business would receive through a wellness program, they could expect to receive $2-$3 in indirect savings through lower absenteeism, disability and workers’ compensation costs and increased productivity.  That could be more than $100,000 in indirect savings. 

Now there is no guarantee that a 50 life case would receive this amount of savings.  In fact, smaller cases receive a smaller savings level because they are fully insured and rated as part of a pool.  However, insurance companies rate up for known ongoing health conditions.  If you can reduce or eliminate known ongoing conditions through wellness initiatives, employers will receive lower increases.   

This is just one of many success stories related to corporate wellness initiatives.  If your business is not doing something today, you should strongly consider investigating your options.  I would be happy to discuss the various options with you if you are interested.  You can read the full article by clicking on the following link:  Kalamazoo County Wellness Article

Have a healthy day!

Have a great week.

It is for this reason that I talk frequently to my clients about offering some level of disability coverage for their employees, whether it is employer or employee sponsored.  Disability coverage is an essential need for employees though few are truly educated on the benefit that it provides and even fewer appreciate it’s value when it is provided by the employer.  The following link (or you can click on the crutches to the right) will take you to a document that discusses the various components of disability coverage as well as things to consider when designing your disability program.  Feel free to contact me with any questions you might have. 

Disability Coverage Overview

The Kaiser Family Foundation is a non-profit, private operating foundation focusing on the major health care issues facing the U.S., as well as the U.S. role in global health policy and is not associated with Kaiser Permanente or Kaiser Industries.

Employee Benefit Advisor Article

First, even though small employers are rated as part of a small group pool, there are also additional adjustments made for each individual employer based on known ongoing health conditions in their employee population.  If it is known that an employee or a family member is having, for example, knee replacement surgery or heart bypass, the insurance carrier will load the premium to account for that additional cost.  This can be a significant additional cost to the pooled renewal premium.  However, if the overall population was healthier, there would be a lower prevalence of these types of conditions…thus lower increases.   

Secondly, health insurance costs are just the tip of the iceberg.  Studies have shown that for every $1 a wellness program saves on health plan costs, an employer can expect to receive another $2-$3 of indirect savings.  Indirect savings are driven by lower absenteeism, disability, Workers’ Compensation and presenteeism costs.  Presenteeism is defined as the cost associated with employees who are less than 100% productive due to health related issues.   

Now it is true that purchasing wellness programs from stand-alone providers can be costly.  However, there are a number of things that small employers can do to help their chances.  Click on Low-Cost Health Activities That Work for a comprehensive list of lower cost programs that can help.  Not all of these will work for your company or culture.  Hopefully, though, you will be able to find a few nuggets that will work for you.  If you are looking for other thoughts on wellness programs, please don’t hesitate to contact us at Tailor Made Benefit Solutions.  Remember, the ultimate answer to our health care woes is a healthier population and anything we can do to help support this initiative will be a win-win for all. 

Have a healthy day!

As you probably know, the House of Representatives passed a repeal bill in a bipartisan vote a few weeks back .  The bill was brought to the Senate floor last week and was defeated along party lines.  Even if it had passed, the President had vowed to veto the bill if it got to his desk.  

While all of this is going on,  a federal judge in Virginia ruled the individual mandate in the health care reform act as unconstitutional.  Then, a federal judge in Florida ruled the entire bill unconstitutional.  The Florida judge found the individual mandate unconstitutional as well.  However, because there was no severability clause in the bill, it was deemed that the individual mandate was essential to the success of the act. 

What is a severability clause you might ask?  A severability clause is meant to protect the bulk of a law in the event that a small portion of it is determined to be unconstitutional. That small portion must go, or be changed, but pretty much everything else is allowed to stand.  Democrats, when writing the bill, left such a clause out of the health care law which could be a critical omission.  

Wisconsin was one of 26 states included in Florida suit.  Wisconsin’s Attorney General came out after the ruling and declared the bill null & void in Wisconsin (see the other link below).  His statement has drawn significant criticism from health care reform supporters and praise from those on the other side. 

Are you confused yet?  Not hard to believe.

With all of this going on, it is my humble opinion that nothing will change for now.   States & insurance companies will likely not pull back from what has already been implemented.  They have invested too much time and money into compliance.   The majority of the other requirements will not become effective until 2014.  I could see the states and insurance carriers slowing down the implementation of further requirements until we have a final ruling…most likely by the U.S. Supreme Court.   That could be a while.  In the mean time, please contact me with any questions you might have. 

PPACA Repeal Update

WI Attorney General Statement on Health Care Reform Ruling (Wisconsin State Journal) 

I hope this is helpful.  Stay tuned for more fun!!

Feel free to call me with questions.

Have a great week!

Have a great day.