• More patients heading to the emergency room
• Inspiration for Unum's simplified benefits platform comes from blue-chip companies
• Editorial: Health Insurance for All
• Businesses Aim to Reduce Number of Sick Days with Vaccinations at Work
• Government Releases Guidelines on Exercise Levels Best for Health
• Just What the Doctor Ordered: Survey Shows Americans Adopting Healthier Lifestyles - Tightening Economy Serving as Tipping Point for Behavior Change
• Congress agrees on mental health bill
• Obama, Dems poised to reshape employee benefits
• Exercise Corner: Do the turkey trot this Thanksgiving
• Recipe Corner: Chocolate Chip Banana Bread

A mounting trend in costly ER visits should raise some eyebrows among HR/benefits professionals who are working to reduce their company's medical expenses.

Emergency room visits increased from 34.1 per 100 individuals in 1996 to 40.5 per 100 individuals in 2006, according to a new report from the Centers for Disease Control and Prevention.

In 2006, patients in the United States made 1.1 billion visits to hospitals and physician offices - or about 3.8 visits per person annually. The research found some disparities by race and insured status. Black patients had higher visit rates to hospital emergency rooms and hospital outpatient departments and lower visit rates to office-based surgical and medical specialists, compared to white patients, the CDC reports.

"ER use is a serious problem both from a quality and a safety perspective," says Helen Darling, president of the National Business Group on Health.
Higher costs

In almost all cases, treatment in an ER costs much more than treatment at a physician's office. "The ER is the most expensive setting for people to get care," confirms Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute.
That's why, for years, employers have been educating their employees about why they shouldn't go to the ER for non-urgent conditions, like a cold or flu. But even so, workers often don't understand when they should and should not use an ER, and they don't always realize how long they'll have to wait at an ER, Darling observes.

Sometimes patients feel the need to go to the ER for a prescription or treatment at night or during a weekend, when their primary care doctor's office is closed. "That's often the case," Fronstin notes. Consequently, some experts have called for expanding physician office hours to cut down on the non-urgent ER visits.

Part of the problem is the shortage of primary care doctors in many parts of the country, which means patients might have to wait for too long to get an appointment with their doctor. "We have a primary care crisis in this country," Darling says. "We need more primary care physicians and advance practice nurses in this country."

One downside to the rise in ER visits is the potential for overtreatment, including unnecessary or duplicate tests and scans. "It triggers all these tests. You wouldn't necessarily be treated the same way if you went for an office visit," Fronstin states.
As expected, certain types of conditions are more likely to be treated in an emergency room than in a physician's office or outpatient setting, mainly because of their urgent nature. For example, 42.5% of drug addiction and drug abuse cases are treated in the ER, and 42% of gastrointestinal hemorrhage cases are treated in the ER. More than half of open wounds and head injuries are treated in the ER, according to the CDC.

The uninsured
Research confirms the belief that uninsured Americans go to hospital emergency rooms when they need care, since hospitals cannot legally refuse to treat a patient with an emergency medical condition. Among the uninsured, the visit rate to emergency rooms is about twice the rate of those with private insurance, the CDC reports.

Likewise, cities with higher poverty rates show greater use of ERs and less use of physician office visits, perhaps because of higher numbers of uninsured residents, the CDC notes.

Dr. Prathibha Varkey, a Mayo Clinic physician who works in preventive and occupational medicine, says, "The ER has functioned as a safety net for people who do not have access to health care. Some of this increase in ER visits is a symptom of access issues."

In general, when hospital bills go unpaid by the uninsured, it results in higher health insurance premiums for those with coverage. "That cost is going to get shifted to somebody. Part of it undoubtedly will be shifted to employers," Fronstin explains.

Solutions
Varkey emphasizes the need to focus on wellness and prevention - through worksite wellness programs, onsite health screenings, health risk assessments and employee assistance programs. She calls for "integrated, well thought-out, population-based approaches for enhancing quality of care," which can include treatment protocols, nurse triage lines, case management and disease management programs.

Fronstin suggests several other solutions to reduce the number of unnecessary ER visits: increase the copay that employees must pay if they visit an ER and are not admitted to the hospital; advocate for 24-hour urgent care clinics; and provide a 24-hour nurse hotline as part of your health benefits. The nurse can quickly give a person advice about whether his or her condition requires a trip to the ER or not.

In fact, 40% of callers to Mayo Clinic's 24-hour nurse hotline choose a lower level of care at the conclusion of the call than they originally intended to seek. About 60% of callers whose initial intent was to go to the ER are redirected to a lower level of care, and 90% of callers agree with nurse's recommendations.

To further encourage employees to use lower-cost settings when appropriate, Darling recommends offering a lower copay for visiting a retail health clinic instead of an ER.

In addition, she suggests, it helps to have good communication with employees about where they can find a retail health clinic or an urgent care center near their home. Medical care tends to costs less in those settings, and it's best to have the location information before an illness or injury occurs. 

Tips for preventing unnecessary emergency room visits:

1. Offer a 24-hour nurse line that workers can call to figure out whether their condition warrants a trip to the ER.
2. Provide disease management programs that help employees keep their chronic conditions from getting dangerously out of control. 
3. Offer wellness programs that motivate workers to exercise, eat healthy foods and not smoke. With a better fitness level, they're less likely to get injured and need the ER. 
4. Tell employees where to find retail clinics and urgent care clinics near their home and office. 
5. Lower the copay for visits to retail clinics and raise the copay for those who visit the ER without being admitted the hospital afterward. 
6. Provide self-care guidebooks that tell employees when an ER visit is needed and when it's not needed.

Source: Employee Benefit News, October 1, 2008

Changing demographics, including an increasingly ethnically diverse workforce with up to four generations of employees, are driving the need to customize employee benefit design, communication and enrollment strategies.

"It was very clear to us that the same trends happening in retirement – moving from a defined benefit to defined contribution approach – are happening in health care as seen with higher deductibles, cost-shifting and consumerism choices," observes Mike Simonds, a senior vice president for Unum, which built its new benefits platform around helping employees make more informed choices.

That same benefits philosophy applies to Unum's core product lines, which include disability, life, supplemental health and long-term care insurance. For example, while 19% of the carrier's short-term disability premiums were employee-paid five years ago, the figure has since soared to 55%.

Mindful of these trends, the leading disability carrier recently launched Simply Unum, which has received numerous honors, including a Top 5 award in the 2008 InformationWeek 500, a 2008 Microsoft Windows in Financial Service Innovator Award, a Visionary Award from Exstream and CELENT Award for document automation.

The single-technology platform targets organizations with fewer than 500 employees that struggle to manage the increasingly complex administrative tasks associated with accommodating employee benefit choices. Employers are able to create one path from the quoting and proposal phase to benefit package design and enrollment to ongoing billing and administration. The beauty of this approach, according to Simonds, is that it eliminates separate processes, workflow and eligibility rules from multiple product lines.

Keeping it simple
The operative word is simplicity. "Why does insurance have to be so difficult when so many other things in our daily lives can be so simple and straightforward?" he asks. Tucked within this rhetorical question is a solution inspired from outside the insurance industry. Unum decided to incorporate into its benefits platform operational efficiencies from four of the world's most successful companies: Starbucks, FedEx, Southwest Airlines and Toyota.

There were several lessons learned. One is that a menu-driven approach that's easy to follow and promotes customization could mirror the brevity of Starbucks' marker board, which allows customers to create virtually unlimited combinations of coffee. In essence, many choices could be made available, but in a straightforward way.

Another is that on-time delivery with a tracking mechanism in place, as is the case with FedEx, can be critical for a disability claim when a family's finances hang in the balance. With this system, they have the comfort of knowing how to check on the claim's status.

Unum also studied Southwest Airlines for greater insight into consistent delivery of outstanding service through high-quality people who raise the bar on customer interaction. The objective was to groom the insurer's best frontline employees, establish customer-service goals and reward excellence.

With Toyota, Unum was impressed by the use of a common automobile chassis to capture manufacturing efficiencies and, therefore, offer affordability with the Camry, but add in options for its Lexus model to meet different customer-segment needs. Unum sought to build product features onto a common platform to offer a base of simple, affordable coverage that can be enhanced with richer, more comprehensive solutions for a customer with more complex needs. With more than 28,000 possible product combinations, Simply Unum provides a base of group disability and life insurance that act as a gateway to other core and voluntary benefits plans.

People and technology
To help distinguish its benefits platform in a crowded marketplace, Unum invested in a new approach to technology that would allow data and process flows to be consistent from start to finish rather than enhance legacy systems. Best-of-class partners were brought in to develop the product's architecture so that the carrier could instead focus on its core capabilities, such as generating the right insurance rates through the quoting process and adjudicating claims. In developing the technology to support the platform, Unum included boutique providers as well as software behemoth Microsoft.

But the thinking behind Simply Unum also was to leverage its people by providing a dedicated team of professionals who offer administrative support and a national enrollment network to help employees make informed decisions. Each of the major communications channels are used to satisfy all customers: face-to-face contact, telephonic support and a Web site for transactions.

The eventual aim of Simply Unum is to broaden its appeal for larger employers and expand the product suite to keep pace with trends. "We've seen the voluntary benefits business grow over the past six years from $9 billion to $19.5 billion," Simonds says. "That kind of rapid growth only occurs when there are a number of things changing in the marketplace. Employers need to find ways to attract and retain talent in the face of ever-increasing health care costs. So providing more choices is a very attractive solution."

Source: Employee Benefit News, October 13, 2008

It is a shame that a discussion of health-care policy has come near the end of the presidential campaign, when the level of discourse is at its lowest.

In the midst of assailing John McCain's mental health -- he is diagnosed as both "erratic" and "out of touch" -- Barack Obama and Joe Biden have pressed an attack on McCain's health-care plan that is deceptive in almost every detail.

McCain has proposed replacing the current government health-care subsidy for employers with a tax credit that would help all individuals and families purchase coverage. Biden terms this the "largest tax increase in the history of America for the middle class." He is off by -- well, by even more than the norm of Biden hyperbole. In fact, the McCain trade-off would result in a significant tax cut for nearly everyone (except those with the highest incomes).

Obama breathlessly reveals that the McCain credit "wouldn't go to you. It would go directly to your insurance company." Since the credit is intended for the purchase of health insurance, where else should it eventually go? Is it a scandal that a child-care credit eventually goes to child-care centers?

"At least 20 million Americans," charges Obama, "will lose the insurance they rely on from their workplace." As Yuval Levin of the Ethics and Public Policy Center points out, this is a distortion. He cites a Tax Policy Center estimate that the McCain plan would result in 21 million people entering the individual insurance market by 2018 -- many because individual ownership of insurance will be more attractive. In every mainstream analysis, McCain's plan would result in a net increase in the number of insured Americans.

Obama terms the McCain plan "radical" -- which is its main virtue. It goes to the root of the problem -- a system that depends mainly on businesses to provide health coverage. Over the past few decades, the rising cost of health coverage to employers has eaten up pay increases, acting as a wage cap and leaving many incomes stagnant or falling. Business-based health coverage leaves many workers afraid to change jobs -- a handicap in the constant employment churn of the new economy. It discriminates against the self-employed and places unique burdens on small businesses. And it insulates workers from decisions about health-care costs. Few in the current system benefit from searching out the best health-care prices and results.

There are really only two visions of health-care reform: using government to increase private insurance coverage or using government to provide health care on a larger scale. McCain takes the first approach. Obama takes the second. Under Obama's plan, medium-size and large employers would be forced either to give coverage to employees or to pay into a new government program, modeled on Medicare, that would provide public insurance. This may sound like a fair competition between public and private, but it isn't. Unlike private companies, government can cut costs by imposing price controls and shifting costs to others (just as Medicare does). Over time, this would give the government an unfair price advantage over private insurance, causing more and more businesses to pay into the public program.

Obama's health plan is really slow-motion Medicare for all. And the problem with Medicare-like price controls is that they reduce the number of people willing to provide medical services, which always means longer lines and rationing.

McCain's health plan has a problem of its own. It is not too radical but too timid. A refundable tax credit of $5,000 per family -- in addition to increased cash wages from employers no longer burdened with paying for health care -- would help middle-class workers get insurance. But for people on the lower end of the scale -- who don't qualify for Medicaid -- the $5,000 credit alone would not be enough to buy adequate coverage, which can cost more than double that amount.

To be a genuine alternative, Republicans should follow their own logic and make the ownership of private health insurance an entitlement. Fund the purchase of a basic health insurance plan completely, through a refundable tax credit, so every low-income American can afford insurance. Help consumers exercise their newfound choice of health plans by requiring the disclosure of comprehensive information on health costs and outcomes.

Universal Medicare is a frightening prospect. But it may be unavoidable unless Republicans can counter the rallying cry "health care for everyone" with a simple and superior alternative: "Health insurance for everyone."

Source: : Washington Post, October 8, 2008

Angie Mills didn't need to make an appointment with her doctor or pay a cent when she received her flu shot Tuesday.

All she had to do was show up for work.

Her Omaha employer offers free flu shots each fall to workers, and Mills doesn't pass up the shots.

Free or low-cost shots at work are becoming more common as employers look for ways to encourage workers to get vaccinated, said Howie Halperin, executive director of the Wellness Council of the Midlands.
 
Major companies offering free or low-cost shots include Union Pacific Railroad, Mutual of Omaha, ConAgra Foods (NYSE:CAG) and Methodist Health System.

Some employers go beyond free shots.

Paul J. Strawhecker Inc., an Omaha consulting firm, provides two extra sick days to employees who get a flu shot.

Union Pacific began offering free flu shots three years ago at many of its locations to increase participation, said Tom Lange, a spokesman. Participation has grown, he said, although specific figures were not available.
More than 12,500 U.P. employees received free shots last season.

Employers want workers vaccinated because it reduces absenteeism and keeps employees from spreading the illness to co-workers. It also can keep down health care costs because workers who don't get the flu also avoid trips to the doctor.

Halperin said the free shots are part of a broader trend of employers offering wellness programs to workers. The wellness efforts, which include health screenings and exercise programs, are aimed at making employees healthier and happier.

Mills said that with two young children, it would be tough finding time to head to the doctor or even stop at a pharmacy for a shot. Free shots at work are easy.

"I just have to walk across the hall," said Mills, a manager at Vertrue, an online marketing company.
Strawhecker said his employees can use the additional sick days to care for a sick child, which some workers consider a plus.

About one-third of the 16 employees take advantage of the free shots, the company said.

Flu shots typically cost between $25 and $30 at pharmacies. At a doctor's office, out-of-pocket costs without insurance can hit $50.

Employers in the Omaha area typically pay about $18 for each shot offered to workers, said Alan Kohll, president of Health Fairs of America. The Omaha-based company provides wellness services, including flu shots, to employers nationally.

That means a company that provides free shots to 100 workers would pay about $1,800.

Offering free or low-cost shots increases participation, Kohll said.

About 10 percent of employees, on average, participate if the shots are full price, he said. Participation increases to about 30 percent when the shots are free or cost $5 or $10, he said.

Some employers who heavily promote the free shots and have been doing so for years can reach participation levels of 50 percent and higher, he said.

Source: Washington Post, October 8, 2008

Get moving: New exercise guidelines released Tuesday set a minimum sweat allotment for good health. For most adults, that's 2 1/2 hours a week.

How much physical activity you need depends largely on age and level of fitness.

Moderate exercise adds up for sluggish adults. Rake leaves, take a quick walk around the block or suit up for the neighborhood softball game. More fit adults could pack in their week's requirement in 75 minutes with vigorous exercise, such as jogging, hiking uphill, a bike race or speedy laps in the pool.

Children and teens need more -- brisk activities for at least an hour a day, the guidelines conclude.

Consider it the exercise version of the food pyramid. The guidelines, from the Health and Human Services Department, aim to end years of confusion about how much physical activity is enough, while making clear that there are lots of ways to achieve it.

"The easy message is get active, whatever your way is. Get active your way," HHS Secretary Michael Leavitt said.

The guidelines come as scientists are trying to spread the word to a nation of couch potatoes that how active you are may be the most important indicator of good health.

Yet a quarter of U.S. adults aren't active at all in their leisure time, government research concludes. More than half don't get enough of the kind of physical activity that actually helps health -- walking fast enough to raise your heart rate, not just meandering, for instance. More than 60 million adults are obese.

Worse, the nation is raising a generation of children who may be less healthy than their parents. About a third are overweight and 16 percent are obese.

Source: Seattle Post-Intelligencer, October 08, 2008

More than half of Americans (51 percent) believe there are good things about the current health care system, but major changes are needed, according to the 2008 EBRI Health Confidence Survey. The survey was released today by the Employee Benefit Research Institute and Mathew Greenwald and Associates Inc., and was underwritten by the Principal Financial Group®.

“The economic crisis is serving as ‘the tipping point’ in terms of how Americans are changing behavior concerning their health care,” said Jerry Ripperger, national practice leader of consumer health at the Principal Financial Group. “We’ve finally reached a place where more Americans are focusing on making smarter health care decisions, and taking more personal responsibility that will improve their health and ease the strain on their wallets.”

The survey indicates that Americans are showing some level of personal responsibility through heightened awareness and action. Two out of five Americans (39 percent) report they are often or always aware of the cost of their doctor’s visit. For example, those Americans who have experienced higher health care costs over the last year:

• Tried to take better care of themselves (76 percent) 
• Chose generic drugs more often (74 percent) 
• Talked to the doctor more carefully about treatment options and costs (63 percent)

The survey indicates that when it comes to reforming the nation’s health care system, Americans said it is “extremely” important to make health care coverage affordable (63 percent), provide quality health care (63 percent), and provide health insurance coverage to all Americans (55 percent).

In order to ensure that all Americans have access to health insurance, those surveyed “strongly supported”:

• Expanding government programs, such as Medicare or Medicaid (43 percent) 
• Requiring all employers to pay toward subsidized health insurance for employees (41 percent) 
• Requiring everyone to participate in some kind of health insurance plan (37 percent) 
• Providing tax breaks to help people pay for coverage they purchase on their own (54 percent) and to help people pay for employer coverage (48 percent) 
• Allowing those who are uninsured to buy into government programs, like Medicare and Medicaid (48 percent) 
• Allowing those who are uninsured to buy the health insurance coverage offered to government employees (37 percent)

The survey also indicated that Americans are beginning to show support for health care infrastructure that provides more transparency:

• More than half of Americans (55 percent) say it’s important for providers to use electronic medical records, and four out of five say these records should be stored in a central location so that their health information could be shared by all health care providers they authorize to use it. 
• More than half (56 percent) of Americans say the total cost of the doctor or hospital would be “extremely” or “very” important when choosing a provider through an objective rating system (if the quality ratings were about equal).

About the EBRI Health Confidence Survey

The 2008 Health Confidence Survey was conducted within the United States May 24 – June 30, 2008, through 20 minute telephone interviews with individuals age 21 and older. The margin of error is plus or minus 4 percentage points. All questions are available on the EBRI Web site, www.ebri.org. EBRI is a private, nonprofit organization committed exclusively to data dissemination and education on economic security and employee benefits; it does not lobby or take positions on legislation.

About the Principal Financial Group

The Principal Financial Group® (The Principal®) is a leader in offering businesses, individuals and institutional clients a wide range of financial products and services, including retirement and investment services, life and health insurance, and banking through its diverse family of financial services companies. A member of the Fortune 500, the Principal Financial Group has $308.0 billion in assets under management and serves some 19.0 million customers worldwide from offices in Asia, Australia, Europe, Latin America and the United States.

Source: Hi-Wire, October 8, 2008

Congress passed legislation this week requiring private insurers to offer the same level of benefits for mental illness as they do for physical aliments. Yet lawmakers still need to hammer out whether the final bill will become a standalone measure or part of a larger bill, reports The Washington Post.

Another issue facing politicians centers on how to pay the cost to the government, estimated at $3.4 billion over 10 years, in the form of tax payments.

Industry research shows that 42 states call for health insurers to cover mental and physical illnesses equally, the Post reports. However, 82 million Americans work for companies that self-insure, meaning they are exempt from state parity laws; and 31 million are in other plans that aren't required to cover physical and mental illnesses equally.

Source: Employee Benefit News, November 8, 2008

Barack Obama's ascent to the Oval Office coincides with Democrats taking firm control over Congress. Such a seismic shift in American politics is bound to redefine the employee benefit landscape.

To help our readers navigate a possible new era in employee benefits, we have created a web page listing resources that explain Obama's policies toward workplace benefits.

For instance, Obama supports health information technology, electronic health records, tax breaks to help working families afford health care coverage and prohibiting insurers from denying coverage based on pre-existing conditions. He also supports an individual mandate to require coverage for children. Obama hopes to reduce health care costs by spending $50 billion on information technology over five years.
"
Now is the time for health care reform, and we look forward to working with the Obama administration and the new Congress to develop workable solutions to the health care challenges facing the nation," says Karen Ignagni, president and CEO of America's Health Insurance Plans. "We support coverage for all Americans, coverage they can afford, and coverage they can keep," she adds.

On the retirement side, Obama favors a penalty-free hardship withdrawal from retirement accounts, but opposes privatization of Social Security. Both he and some Democrats have proposed creating a government-sponsored defined contribution plans for employees who don't have access to the accounts. The government would make matching contributions.

"The most urgent retirement security issue facing our nation needs to be resolved before President-elect Obama even takes office," says James Klein, president of the American Benefits Council, a Washington, D.C.-based employer group.

Klein contends that, given the current financial crisis, Congress needs to amend the Pension Protection Act to provide greater leeway for funding defined benefit pension plans. "It is imperative that Congress return for a lame-duck session and that President-elect Obama bring his influence to bear for a swift resolution to this problem," says Klein, adding that failure to do so will trigger a wave of pension plan freezes and job cuts.

"Longer-term, the new Administration and Congress must recognize that encouraging savings represents not only a source of retirement income security, but also boosts investment capital so vital to economic recovery," he adds.

Source: Employee Benefit News, November 6, 2008

Most of us end up feeling like a stuffed turkey after Thanksgiving. But once you’ve enjoyed your meal and had some time to relax, why not get the whole gang moving rather than hitting the couch?

You’ll all feel better once you’ve snapped out of that turkey coma. Plus, exercise can be a great way to spend time together as a family.


Here are some ideas for family fitness fun to enjoy over the Thanksgiving holiday:

*Turkey trot. You don’t have to run like participants do in some of the organized turkey trots around the country. You could go for a light jog or even just take a brisk walk. Bring the dog along, too. Enjoy the company and the autumn scenery -- the sky, sunset and fall foliage. A good 20-minute turkey trot will help you feel refreshed and energized.

*Flag football. Football is the game du jour for Thanksgiving. But instead of watching it on TV all day, why not get a game of your own going? You probably have enough participants around the house to make for one lively showdown.

*Wheelbarrow races. Turn raking the leaves into some good old-fashioned fun. Gather the leaves up, jump into the piles and then get some wheelbarrow races going.

After all this activity, you might just have enough energy to slice a little piece of pumpkin pie when you head back indoors.

Source: The Fit List, November 2008

This banana bread has something a little extra in it: Chocolate! Chocolate chip banana bread is a great way to use up the overripe bananas sitting on your counter or kitchen table. The bread can be eaten as a dessert or it can be a tasty part of your work lunch. Recipe makes 1 loaf.

Prep Time: 15 minutes
Cook Time: 50 minutes

Ingredients:

3 ripe bananas, mashed
1/2 cup shortening
2 large eggs
3/4 cup sugar
1 tsp vanilla extract
2 cups all-purpose flour
2 tsp baking powder
1/2 tsp salt
1 cup chocolate chips


Preparation:
Preheat oven to 350 degrees F. In large bowl, mash bananas with fork. Add shortening, eggs, sugar, and vanilla. Blend well. In separate medium bowl, mix together flour, baking powder, and salt. Slowly pour and stir flour mixture into banana mixture. Mix in chocolate chips. Grease inside of 9 x 5-inch loaf pan. Scrape batter into pan and bake for about 50 minutes or until a knife (or toothpick) inserted into the center comes out clean. Remove loaf from oven and let set for 15 minutes until turning loaf out onto rack to cool.