A very cost-effective way to create ROI within your health plan spend
Several years ago, my firm received a call from a lab that we had contracted with on behalf of one of our Tribal casino clients. They had just completed the lab work for a biometric screening sponsored by the casino for its team members and spouses who are covered under the self-funded health plan. The lab, which was local to our office, said, “You need to get down here and see this …” Upon arrival, we were shown a blood test vial with a pink substance inside that had the look and consistency of Pepto-Bismol. We were told that this was actually blood, which had been drawn from a team member during the biometric screening fair sponsored by the casino. The team member’s triglycerides were near 1,500 (healthy is under 150, borderline high is 150 to 199, and high is 200 and above). We immediately shared this information with the casino’s large case management and disease management firm, who performed an outreach call to urge the team member to head straight to the emergency room.
When we reported this situation (minus protected health information, of course) to the casino’s health plan committee, the logical question was asked: Why was this team member not being managed by either the disease management program or the large case management program? The answer to this question was simple; this team member was not on the radar, even though the situation was a ticking time bomb. In order for a medical management firm to intervene, the member must show up in either a large claim report, a diagnostic code report, or a pre-authorization report. In this situation, the member didn’t show up in any of these reports as they had not been to the doctor. Therefore, there was no claim submitted to the health plan administrator or a pre-authorization call made to the utilization review vendor, and as a result, the team member didn’t show up on any of the necessary reports.
This story does have a happy ending!
The team member did seek care, was prescribed the necessary and appropriate prescription drugs, and started to lose weight. Several months later, he stopped by Human Resources and told the HR Director that the casino had saved his life. He stated that he had felt terrible all along, but didn’t know any different, so he never went to the doctor. Not only is he feeling better, but HR has reported that the team member’s attendance, along with his productivity, has drastically improved. The other positive in this story is the cost avoidance that the health plan realized, because this team member was helped prior to becoming a very large claimant.
The health plan return on investment as it relates to biometric screening has been proven over and over again; however, many employers have a difficult time finding the money to pay for these programs. In addition, getting the participation needed to achieve a return on investment can be challenging. With some creative payroll contribution strategies, the casino can achieve over 80% participation without increasing plan costs; therefore, any savings achieved by the biometric screening would equate to a positive return on investment.
What’s a biometric screening, and how does it differ from an annual check-up?
Incentivized, employer-sponsored biometric screening is typically an annual event used to provide the team member with basic biometric data, as well as non-identifiable aggregate data for the employer. It is typically performed on-site at the employer (say, through a “health fair”). These on-site events, with the right incentives, might be the only “check-up” that team members do for themselves, especially if they are averse to going to the doctor for even a wellness visit. These tests typically provide blood pressure, body mass index (BMI), cholesterol and glucose, and can be provided to a team member’s primary care doctor at the time of an annual physical examination, so they don’t need to be repeated again.