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Manage Health Care Costs With Supplemental Programs

By Phil Brit | May 9, 2018

To better manage your fund's health care costs, consider implementing a supplemental program to coordinate care and aggregate health data gathered by primary physicians and other health care providers.

As discussed in a Society for Human Resources Management (SHRM) article, "concierge care" — a primary care physician handling the most common care needs — has resulted in nearly $1 million dollars in savings for Union County, N.C., compared to what other options would have cost. Additionally, more than 90 percent of the county's workers with two or more chronic conditions were "highly engaged" with their physicians and were taking active roles in managing their health. Typically, the better health is managed, the quicker any issues can be addressed.

Find Early and Save

Early detection for breast cancer is critical, and the same can be said for other cancers and diseases. According to the Harold C. Simmons Comprehensive Cancer Center, a little more than 12 percent of women will have breast cancer during their lifetimes, but early detection improves the survival rate to approximately 100 percent. If a health care issue is diagnosed early enough to administer treatment that keeps someone out of the hospital, it'll save an average of more than $1,750 per day, according to a report from the Kaiser Family Foundation.

Supplemental plans can help in this regard because eye exams can uncover issues such as high blood pressure and diabetes before a member has a planned tests for those health issues. Similarly, dentists can uncover these and other health issues. Including pharmacy coverage in a supplemental plan can help ensure that a patient receives his or her prescribed medicine(s) and in the right dosages while helping to prevent overprescribing of medicines. A Daily Advertiser article discussed how overprescribing is leading to higher insurance costs.

It's important to note that some supplemental plans may include additional cleaning and vision tests for diabetic patients, resulting in better total care for them and lower costs for the fund. However, this is only if supplemental care is integrated with primary care. That additional cleaning aids in better condition management, and ultimately, lowers the cost of care for the fund. With such integration, the referrals are automatic, so no costly human agent involvement is necessary.

The key to the Union County success, according to the SHRM article, is that the primary physician is the "quarterback" for the patient's care, working with specialists in specific disciplines for the best overall results. Another essential element of coordinated care is a system for securely recording and storing all pertinent health care information, so it can be accessed as needed by all providers and physicians.

Look at Costs, Benefits

However, not all supplemental programs may make sense for your particular case. While members may benefit from eye exams, the cost of glasses or contacts may be something to be borne by the members. According to Bankrate, a box of six soft contact lenses ranges in cost from $22 to $26. A Consumer Reports article puts the cost of glasses from anywhere between $184 and more than $400, depending on the type of prescription, frames, etc. You should carefully examine the costs and benefits of any plan you consider. Providers can provide calculators to help determine the plan and supplemental offers that provide the best return on your investment.

By carefully examining supplemental plans that provide more comprehensive care for your members, you'll better control the health care costs of the benefits program you offer while having healthier, happier and more engaged participants.

Phil Britt has worked as a journalist for 40 years, specializing in business issues for the last 30. His work covering the steel industry and its labor issues has been referenced in books, while his articles have appeared on numerous websites, national and international publications. Among current and past clients have been the American Medical Association, Afcom, the Credit Union National Association, Independent Banker, EH Publishing, the Southeast Chicago Development Commission, the Northwest Indiana Times and Insurance & Technology Magazine, just to name a few.

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