Mar 18, 2014 - By Eric Blom, Staff WriterFremont County is betting heavily on an expanded wellness program for its employees, and the wager could pay off. Groups that have tried similar methods have seen fewer claims and a leveling off of coverage costs.
"Facts and figures around percentages with regard to impact on plans are a little hard to come by, but generally we see very positive impact by bringing in a wellness program," said Rob Henderson, vice president of sales for health insurance consultant COBECON. "It's hard to prove someone didn't have a heart attack because of a wellness program."
One organization that instituted such a program is Wyoming Medical Center in Casper. WMC, like the county, is self-insured. The hospital revamped its wellness program in 2010. Since then, claims have gone down and the cost of coverage to employees has not increased.
Claims drive costs for self-insured organizations. Under the system, an employer pays into a pot of money a certain amount for each employee who wants coverage. Employees typically contribute a smaller portion as well.
After deductibles, co-pays and out-of-pocket limits are met, the pot of money pays the medical bills of covered individuals, just like standard health insurance. Whereas insurance companies can raise premiums to cover increased costs, self-insured groups have to put more in the pot themselves when expenses rise.
Wellness programs encourage employees to be healthier with the goal of lowering their health care costs and saving the organization money.
A 2013 survey from the Society of Human Resource Management found 64 percent of employers nationwide had a wellness program and 43 percent of those include an incentive.
In 2010, WMC instituted the largest monetary incentive it legally could, a 20 percent differential for workers who joined the wellness program, said WMC benefits representative Vili Petkova. Under the system, if, for example, an individual normally paid $100 a month for his health insurance, he could pay $80 if he participated in the wellness program.
On Feb. 4, the Fremont County Commission doubled the county's incentive to $1,200 a year for each covered adult who participated fully in the county's wellness program.
A study found that employers who offer a cash incentive see participation between 75 percent and 100 percent, said Dianna Madvig of COBECON.
WMC's experience was in line with the trend; it had 85 percent to 90 percent of those eligible participate in its wellness program. Fremont County hopes eventually to have an 80 percent participation rate but expects 40 percent in 2015.
Petkova said WMC's consultants told her the incentive could take two or three years to have an effect, but she has seen changes already.
"Last year we did see a reduction on the claims, but I cannot say it was only due to the wellness program -- we had other restructuring of programs," she said.
Costs actually can rise in the first year of a wellness program because more people become aware of health problems and seek treatment for them, Henderson said.
"That 45-year-old that had high cholesterol, now he's going to see his doctor," he said.
WMC saw success in other ways, such as not having to increase the amount employees pay for coverage for four years, Petkova said.
The hospital's wellness program involves more than a monetary incentive.
"There's a culture of taking care of yourself," said d'Ann Miller, a nurse practitioner at WMC.
Part of that culture includes free flu shots for employees, Miller said.
She runs a case management program, which is in its third year. Miller works one-on-one with people in the wellness program to achieve their health goals. About 35 people participated in the program, and more than 50 percent were successful with their health goals.
WMC also uses a set of tests to target certain diseases.
To qualify for a rebate in their premium, covered individuals have their blood tested for health issues such as cholesterol level and tobacco use. Employees also fill out a health risk assessment.
Afterward, the results of the tests are turned into a numerical score. If employees have a score of -20 to zero, they qualify for the rebate. If it's above, they are given a target number they have to reach before they receive the monetary incentive.
The formula for converting test results to a single number came from WMC's consultant, Interactive Health Solutions.
To qualify for Fremont County's new incentive, employees would have to undergo similar tests. Employees would get a rebate, however, for meeting a standard in each of several factors.
Both programs are aimed at managing and preventing chronic illnesses such as diabetes, coronary artery disease, hypertension and high cholesterol.
People have a high ability to change their medical outcomes related to those conditions, Henderson said.
"Those are some of the highest impact areas in terms of reducing costs," he said.
Fremont County's wellness program shares many aspects with successful ones, but it will be several years before the county knows whether it helps covered individuals be healthier and saves taxpayer dollars.
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