🔒Cutting weight, health care costs with employee wellness programs

Dan Bookham enjoys his work at Allen Insurance and Financial, where he's the business development director and a commercial insurance producer at the firm's office in Camden.

But over time, he became increasingly sedentary and his diet worsened.

“Coming into this role, I found myself between a desk and computer or in my car, eating chicken strips at gas stations,” he says. “I gained weight and began to have concerns, as I was heading into my 40s, about my overall health.”

Two years ago, he began taking advantage of a new program provided through Allen in partnership with Patient Advocates, a company in Gray that provides patient advocacy and disease management services, wellness programs and benefit plan designs. The program includes annual health screenings and health coaching as needed. Bookham meets with the health coach once every couple of months, with more frequent meetings if needed.

“I found it incredibly beneficial,” Bookham says. “I've been able to take control of my diet with their support. It's useful information that's tailored for me. And the proof is in the results. My bad cholesterol is down and my good cholesterol is up. My blood sugar is down, and my weight is down about 15 pounds.”

Being in the insurance industry, he says, he also understands how services such as Patient Advocates can help not only employees, but employers.

“There's a great phrase, 'enlightened self-interest,'” he says. “That's perfect, because employers have a vested interest in helping their employees stay healthy or manage their chronic conditions” to control health care and absenteeism costs. “It not only feels good that they want me to stay well. It also drives down the cost of health insurance for all of us.”

Navigating the health care system

These days, in a confusing environment of skyrocketing health care costs, a multi-faceted health insurance landscape, changing health care needs and trends toward holistic health management, employers and employees alike might understandably need help navigating health care options.

In comes Patient Advocates. With an overall and long-time understanding of this environment and its shifting ways over the years, and cultivating long-term relationships with essential players such as nurses and hospitals, the company deploys its triple tactics — patient advocacy, health plan design and administration and wellness programs. It customizes strategies based on an employer's needs, while yielding a $3 return on every dollar clients spend on its services, founder and President James Ward says.

Patient Advocates was established in 1995 and today serves about 30 employers with a total of 12,000 to 15,000 employees. But Ward has been offering comparable services since 1980.

“Health care costs were a problem back then — not to the extent they are today, but the issues and the solutions are essentially the same,” Ward says.

The issues revolve around unmanaged health and the resulting need for medical care. A big part of the solution is helping folks to understand how to lead a healthier lifestyle.

“Seventy percent of medical claims could be avoided if people simply took better care of themselves. That number has been consistent for 30 years,” Ward says.

At Allen, Bookham provides an example of how well that's been working for him. Ward cites another example around diabetes: “What we've done that's been particularly beneficial for clients in rural Maine, is bring them a diabetes management program through telemedicine at the workplace” in cooperation with Tufts Medical Center. “That's been wildly successful.”

Essentially, Patient Advocates offers connections and an overall understanding of the medical community that evolves with up-to-date information. That bird's-eye view means the company can continually negotiate on behalf of the client in a shifting environment. And they can think outside of the box for care that will keep rates down.

Take, for example, the Saturday mammogram preventive screening program Patient Advocates negotiated with a number of Maine hospitals on behalf of their clients.

“The facility isn't usually open on a Saturday, but the hospital still has the costs, so what we say is, 'Tell us how many people you can process at your mammogram unit and give us a fixed price, and we'll fill it,” Ward says. “The hospital is happy because it's getting revenue. And for the employer it's a win-win, because the cost is about half what it would normally be, it doesn't take time out of the patients' workday, and more of their employees are getting regular breast cancer screenings at a time when the numbers have been declining nationally.”

Long-term relationships with providers are key, says Ward.

“For example, with cancer patients, we will get them immediately to a world-class cancer treatment center like Massachusetts General Hospital or Dana Farber,” says Ward. “We've worked with those organizations for close to 20 years. We can get patients in quickly.”

Those relationships are then built into advantageous health insurance plans that Patient Advocates helps companies develop with their insurance providers.

“For example, we can help a company craft a plan that pays 100% of the cost at these facilities, with no deductible, and patients will be reimbursed for their travel,” says Ward. “The plan will cost less than if the client developed it themselves, with savings, on average, 20% below market rates.”

Such savings are possible because, often, higher volume and latest techniques mean urban centers can provide superior services at a fraction of the cost of local services, he says.

“The fact is, inpatient hospitalization at a leading medical center in Boston is about half the cost of what we would encounter in Maine — and we can get them in faster,” Ward says.

Fast-growing profession

Patient Advocates is part of a fast-growing profession, according to Baldwinsville, N.Y.-based Alliance of Professional Health Advocates founder and Executive Director Trisha Torrey.

“The presence of an advocate can contribute to a reduction in the rate of absenteeism and 'presenteeism,'” says Torrey. The latter is when an employee is at work but not working due to time spent — such as calling a doctor — on behalf of a sick family member. “Presenteeism is sometimes cited as more of an expense to employers than absenteeism. Absent people are taking their sick days or not being paid. Present people are being paid but not doing their work.”

APHA is one of two professional organizations in the nation to provide continuing education and support to patient advocates. The National Association of Health Advocacy Consultants provides support for advocacy itself, such as guidance for best practices. APHA provides business support for the legal, insurance, financial and marketing concerns of private, independent advocates. An educated estimate of the number of privately paid professional advocates is about 350, expected to double over the next decade. There aren't enough advocates to meet demand. Although cities in the Northeast and areas with large senior populations are fueling the increase, most areas know little about patient advocacy, Torrey says. 

“If you go to Maine or Syracuse or the Midwest, except Chicago, people say, 'What's a patient advocate?'” she says. “So it's growing, but not as fast as we would like.”

A variety of factors are fueling growth, including the Affordable Care Act, says Torrey.

“It used to be, people called visited the doctor, got a prescription and went home,” Torrey says. “Now people are paying attention” to the cost and quality of health care. Also, she says, aging baby boomers and a confusing healthcare system overall are fueling growth.

Of APHA's 600 members nationwide, about 60% come from a medical background — nurses, physicians or affiliated professionals. The rest entered the field as individuals who grew frustrated with the confusion of the health care system when they navigated it for their own care or on behalf of someone else, she says.

“So these are people who want to make sure that whatever happened to them doesn't happen to anyone else,” she says. “I don't know of any other profession that starts that way.”

Controlling costs

At Allen Insurance, several years of pretty significant claim expenses for its employee health insurance plan drove the decision, about six year ago, to focus on wellness and eventually contract with Patient Advocates, says Sherree Craig, the senior account manager in Allen's insured benefits division.

As someone who secures health insurance programs for other employers, Craig has witnessed the rise in demand for wellness programs as a key component for trying to maintain control over costs.

“So it was natural that Allen would take up that opportunity as well,” Craig says. “There was a hope that we could control some of those costs that might be related to lifestyle choices. There are some many diseases today that are a result of the choices we make. We also take a close look at our claims activity to see if there's anything in there that we can directly impact with day-to-day campaigns. For example, we have quite a few people here who have cholesterol issues, so we can focus on educating employees on cholesterol and how to make changes.”

While some companies immediately look for a return on their investment—reduction in health claims and premiums — it makes more sense to measure a program's success by the overall wellness of individuals, says Craig.

“If you focus on that, your program is probably going to be a success,” she says. “And if someone moves from a high- to medium-risk category in a disease then, in the long run, you're also going to have a return on your investment reflected in your health plan.”

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