The evolution of healthcare and benefits has continued to put Chronic conditions at an inflection point for employers. As a multifaceted risk to cost and the workforce management of chronic conditions has become a hot button issue for all employers. It is with this in mind that we have created a Leaders Live panel discussion—"Advancing Chronic Care: Strategic Support for Health and Cost Management" Chronic conditions are a dual risk for employers – both significant drivers of healthcare costs and strains on their workforce. As businesses look to manage these rising expenses, it is becoming clear that cutting benefits is not a sustainable solution. Instead, the key to lasting impact lies in investing in personalized, preventive, and integrated care solutions that keep costs down and health up.
Tune in on Wednesday, October 29th at 2 pm ET as Ginger Miller, Director of Health and Benefits, Utz Quality Foods, Patrice Johnson, Director, Benefits & Wellbeing, MGM Resorts International and Jeff Jacques, Chief Medical Officer, Personify join Alyssa Place, Editor-In-Chief on the Employee Benefit News LEADERS Channel to discuss how Data Driven Health Plans are redefining benefits and driving results for employers and employees alike.
Topics discussed will include:
• The financial and human impact: Exploring how chronic conditions influence both employees and caregivers.
• Moving beyond benefits cuts: Why reducing benefits is a short-sighted approach and what more effective alternatives exist.
• The power of personalized benefits: How tailored benefits and targeted support programs can drive cost savings and enhance outcomes.
• Enhancing engagement: Strategies for improving engagement through personalized experiences and data-driven navigation.
Speaker Bios:
Jeff Jacques
The doctor is in! Personify Health's chief medical officer, Dr. Jeff Jacques, is a physician executive leader and entrepreneur with more than 20 years of experience building solutions that deliver personalized support for individuals experiencing complex care journeys. At Personify Health, he focuses on ensuring alignment with member and market needs, enhancing the company's behavior science approach, and exploring additional ways our unique capabilities can further simplify and support the member journey.
Patrice Johnson
Patrice Johnson is the Director of Wellbeing & Benefits at MGM Resorts International, where she leads the company's health, wellbeing, and engagement strategy. She brings over 20 years of experience in global employee benefits, having worked at organizations such as MetLife, Aon, and Electronic Arts. In her current role, she focuses on building a rewards strategy that supports the physical, emotional, financial, and social well-being of MGM's leaders and team members, with the goal of fostering a culture where all employees can truly thrive.
Outside of work, Patrice is deeply committed to community impact, particularly in the fight against human trafficking and supporting survivors. She also serves on the board of NAMI Southern Nevada, working to improve access to mental health resources across the community. She lives in Las Vegas with her husband, four children, and two dogs. Whether at work or in the community, her mission remains the same: to create spaces where people feel valued, supported, and empowered to succeed.
Ginger Miller
Ginger Miller is a strategic leader in employee health and benefits, with over thirteen years of experience designing and implementing innovative programs that improve wellbeing and manage healthcare costs for thousands of associates and their families.
As Director of Health and Benefits at Utz Brands, Ginger leads the development of the organization's value-based benefit design and delivers data driven impactful health initiatives across the organization to control costs and population health. She also oversees the medical leave and accommodations program.
During her time at Utz she created the first health and wellness program, opened an onsite fitness center and primary care clinic, and developed a direct contract joint replacement program with a local hospital system. She has implemented numerous point solutions and programs to support associates and families in optimizing their physical, mental, and financial health.
Ginger began her career as an Occupational Therapist, earning multiple clinical certifications and accolades for excellence in patient care. She holds a Bachelor of Science in Occupational Therapy from Elizabethtown College and is a Certified Lymphedema Therapist and Certified Ergonomic Assessment Specialist.
Her work has been recognized with the BSBP Excellence Award, Capital Blue Cross Worksite Wellness Award, Central Penn Business Journal Healthcare Hero Award, and the Shelby Report's Women of Influence Award.
Ginger is an active contributor to professional and community organizations, including:
- National Alliance of Healthcare Purchasers Leadership Council co-chair
- Hanover Visiting Nurse Association Secretary
- Central Pennsylvania Business Group on Health
- Greater Philadelphia Business Coalition on Health
- Utz Women's Mentoring Employee Resource Group founding member and past chair
- Utz Community Council member
Ginger resides in Hanover, PA with her family and enjoys an active lifestyle—running, biking, hiking, practicing yoga, reading, and traveling. She has a passion for learning better ways to improve the health and well-being of our communities and improving access to care for all.
LEADERS is a flagship channel spotlighting C-level executives and top experts as they share insights on the transformative issues shaping employee benefits. Designed for an audience of key decision-makers, the series delivers forward-looking thought leadership on the most pressing challenges and opportunities in workforce well-being, health care, and benefits strategy. The LEADERS series is made possible through the support of top industry collaborators, including Personify.
Transcription:
Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio for the authoritative record.
Alyssa Place (00:18):
Hi everyone, and thank you so much for joining us for Today's Leaders event around the rising costs of healthcare and why cutting benefits is not the only answer. I'm Alyssa Place, editor in Chief of Employee Benefit News, and I'm joined by a top-notch panel of benefit leaders and experts on chronic condition management. Today we have Ginger Miller, director of Health and Benefits at UTS Quality Foods, Patrice Johnson, director of Benefits and Wellbeing at MGM Resorts International and Dr. Jeff Jacques, chief Medical Officer at Personify. So today we'll be exploring the financial and human impact of chronic disease alternatives to high cost medications and how personalized benefits and primary care can really move the needle on engagement and prevention. We're going to walk away with data-driven strategies to manage costs while improving employee health outcomes. So let's dive in. I wanted to start by asking each of you about the chronic conditions that are really dominating your healthcare spending today. And Ginger, can you talk us through some of those biggest cost drivers that you're seeing in 2025?
Ginger Miller (01:23):
Sure. Thank you for inviting me today. I don't think it'll be startling to anyone that diabetes is certainly at the top of our chronic conditions that impact our organization. Underlying with that is obesity. We see a significant rise in our cardiovascular disease. The impact of that on our high cost claimants in the past year has been a significant other than that, we see GI issues have crept up quite a bit over the past two years, and that impacts a lot of our organization. In many ways, we see some smaller things like migraines that seem to creep up there as a chronic condition as well, but I would say the cardiovascular and the diabetes definitely dominate along with some underlying other issues. Another issue that we've seen significant impact with some high cost claimants that is a chronic condition is kidney disease, chronic kidney disease. We have quite a few individuals that receive dialysis, so that is another big impact to our organization financially and from the absentee presentee issues that we have.
Alyssa Place (02:40):
And Patrice, is that resonating with you? What are you seeing at MGM?
Patrice Johnson (02:45):
Yeah, so we, for us, our number one condition has been MSK. So musculoskeletal for the past several years, it's been pretty consistent in addition to MSK, the entire cardiometabolic spectrum as well as cancer. And so we have really been focusing on those three areas and what can we do to better support our population with each.
Alyssa Place (03:16):
And Dr. Jeff, does any of this surprise you? Are you hearing anything that's making you raise your eyebrow at all or what's your reflection on that?
Jeff Jacques (03:24):
No, I think that these resonate and they'll be slightly different for slightly different demographics just depending on what the demographics are for an employer will drive incidences a little bit differently. I think that when we think about the increase of costs, I think about pharma and specialty pharma drug costs have significantly driven increases. As Ginger alluded to, we have really a national epidemic of obesity, which is an inflammatory state which predisposes to hundreds of conditions. And so that's another significant driver. And then inpatient care, the inflationary impact to inpatient care stay in costs have not returned back to pre pandemic levels. So that continues to be an issue and I think that we are seeing in the data that we are talking about now, we're really seeing the impact of the delayed care that occurred as a result of shelter in place and avoidance of care delivery sites unless you had COVID and or a related COVID issue. So there's a lot of just accumulated neglect and decay that has occurred over a period of a year, year and a half, maybe two years during the pandemic itself.
Alyssa Place (04:53):
That's really interesting. Ginger, are you seeing that in your workplace population that delayed care that Dr. Jeff was talking about there?
Ginger Miller (05:00):
Yes, we do definitely, and I'm very surprised. I mean, there was no doubt that was occurring during COVID, but we figured with things opening up our campaigns that we are allowed about as far as cancer screenings and early intervention types of things, there's definitely delays still in care. I think a lot of healthcare costs in general impact that people delay an ache or pain or some small symptom that they think they can get by with, and that delayed care leads to more significant staged conditions, whether it be cancer, whether it be something else. Diabetes has increased, whether the chronic kidney disease has increased. We've definitely seen a lot of that in addition to just not participating in the cancer screenings that we had seen years ago, which is really astonishing for as many campaigns as we put out there. The cost of healthcare, I have to say, is a driver that people's lives seem to be a little bit busier and chaotic as well, slowing down to do these things, but all of that definitely resonates with our organization. And
Alyssa Place (06:12):
Infantries, what about you
Patrice Johnson (06:14):
With our organization? I would say some of the delay to care really is about more so the demographic of our population, just majority frontline employees, A lot of shift work. I think a lot of it is finding the time or prioritizing the time to see a doctor. So I think that is what we're really seeing come into play. We have seen for those of our employees that are engaging with their PCP on an annual basis, we are tending to catch things earlier. So it has worked in our favor when we're getting employees to go see their primary care physician.
Alyssa Place (07:03):
And I do want to circle back to the importance of preventive care, but I want to continue to just drill down into what those high cost conditions really are. We often hear that statistic that 80% of costs comes from just 20% of your employer population, employee population, excuse me. And what are those most expensive conditions that you are dealing with Dr. Jeff? What are you seeing in terms that is really driving that 80 20 spend right now?
Jeff Jacques (07:33):
I mean, so the normative distribution of costs and impact of costs over population is going to stay, usually stays around that number. I think hidden in that number is that the tide that has risen, has risen, has raised all boats, so that 80% costs more than they used to, but the 20% continue to be an outlier when it comes to overall costs and continue to drive the majority of costs. I think if you look at more recent sort of data from BGH and others, cancer costs overtook MSK for the first time right around 2022, and you can't listen to lay press or lay literature without seeing mention of accelerated cancers or advanced stage cancers being found, including in increasingly younger individuals. MSK usually is number one, it's number two right now. Not arguing with you, Patrice, just saying that in general across the nation, it would appear to be in second place. And then I think cardiometabolic.
(08:44):
But again, I think hidden inside of that data is the fact that inflammation is really a key factor and a key problem, and we think of inflammation as you burn yourself while cooking or you injure yourself while maybe playing pickleball or something and you have now an injury and that inflammatory process, which typically goes away. But chronic inflammation is a hidden problem that most of us suffer from degree. If you don't sleep well, if you don't have good sleep hygiene, if you don't exercise as much as you probably should if you're eating processed foods, all of those things impact overall inflammation and inflammation then is the setup for chronic conditions like musculoskeletal problems that come from increased weight and increase, therefore pressure on those joints. Diabetes is an inflammatory process. Cardiovascular disease is an inflammatory process, so inflammation is really the underpinning. We just give it other names like MSK and diabetes and cardiovascular disease.
Alyssa Place (09:59):
Interesting. Patrice and Ginger, do you have any thoughts on that or are you seeing that in your populations as well?
Patrice Johnson (10:08):
Absolutely. That resonates. Ms. K for us, like I said, is our highest cost. However, cancer and cardiometabolic are following right behind when I think about the demographic of our population, again, when they're on their feet. So I think that helps exasperate some of the inflammation, the MSK conditions. And so this year in particular, we have really been trying to focus on how can we better address that, how can we address that from a more preventative end? And so putting in some new solutions to try to help
Ginger Miller (10:49):
Help. I would also add that we don't talk enough about the inflammation, neither do the primary care physicians. So I think that's an interesting perspective for sure. That is very much underlying what we've seen when it comes to that 80 20 spend. Completely agree with you when it comes to that. The smaller percentage of the population drives a majority of the costs. This year, we have just seen a dramatic increase in significant cardiovascular events. So strokes, heart attacks, it was mentioned that the inpatient stays have increased significantly. So those are some of the biggest drivers of our costs that we're seeing also, it's interesting when you mention the inflammation, I believe that leads to some of the things that we have with the migraine issues, although they aren't the top drivers, but the migraine issues and the GI issues that we're seeing, the GI issues are definitely increasing significantly. So I think a lot of that underlying inflammation can lead to a lot of those issues as well.
Alyssa Place (12:03):
Yeah, and I thought it was interesting what Dr. Jeff was saying about how exercise sleep, these very low cost and often free solutions here. So I wanted to start getting into a solutions portion where we really dig into maybe a more holistic approach to how you're handling these. So when you're managing chronic conditions more holistically, what alternatives are you all turning to at your organizations to maybe avoid some of the traditional medical pathways that could really drive up those costs?
Ginger Miller (12:38):
Well, I'll start. We have always had a fairly robust health and wellness program, so we try to address and campaign about information around healthy lifestyles. And when you have individuals working 10, 12 hour days, it gets a little tricky to find time to do those things. So sometimes it's just words and it's really tough to get people to do that. So we years ago put in an onsite primary care clinic in one of our largest locations, our corporate office, so to speak. And I believe that is definitely the foundation for starting to manage a lot of these conditions, having that relationship. We spoken about this for years, lifestyle, lifestyle, going to your doctor, having that relationship, but it's really hard to get there. Having a free clinic for individuals to go to and spend as much time with these providers has just been a game changer for us.
(13:44):
I mean, it hasn't completely resolved our issues, but it's certainly those that engage with that onsite physician and has that time to go through their chronic conditions or go for an acute visit and the doctor is able to bring up other things that they have been treating them for, definitely has a huge impact on the population. That's where I would start with things. We've increased that primary care. We can't put a primary care clinic in all of our locations. We don't have a large enough population. So we did extend that through a virtual primary care option. We drive people to these programs by having a wellness rewards program where the reward comes from attending your annual physical and going through the basic biometric screening, knowing some of your numbers, but not only knowing your numbers, but having those numbers addressed. So that's probably our biggest solution that we have in place. There's many other smaller ones, but I'll start with that and can expand upon that as we go on.
Alyssa Place (14:52):
Great. Yeah, I mean it's pretty rare to have onsite clinics. I think that's an incredible benefit that you've offered. Patrice, I don't think you have the onsite clinic, but how are you collaborating with other primary care physicians in the community to really get that type of care to your employees?
Patrice Johnson (15:10):
Sure. So we have a unique arrangement in Nevada. So we have a direct contract with a little over 20 primary care providers in the Las Vegas area, and our largest health plan incentivizes our employees to see their primary care provider at least once a year for your annual physical, get your biometrics. But we also incentivize our providers to on quality based outcomes. So making sure that the providers are spending an ample amount of time with our employees, making sure that they're getting those employees in within a reasonable amount of time for acute visits and when they receive those biometric results, making sure they're spending the time to talk through the results with the employees. And we also, because we have such a close relationship with that group of 20 doctors, we're able to better educate them on some of our point solutions. And so the providers can refer employees into the solutions that make sense to help address whatever conditions that they may be dealing with. In addition to that, we have health coaches on site at the majority of our properties, and that's just another resource to help hold our employees hands when it comes to nutrition planning or if somebody doesn't know where to start in terms of building a workout plan or exercise plan, just someone that helps them build healthy habits
Alyssa Place (16:54):
And that benefits navigation piece is so critical. And Dr. Jeff, I wanted to ask you about Personify and how that platform is doing that for your employer and employee clients.
Jeff Jacques (17:05):
Yeah, we have the privilege of working closely with and covering over 25 million American and outside of the US employed lives today. And really if you look at the NIUs of the company and its evolution over the last 20 years, what we've really done is iterate on how to engage individuals, which is really around understanding the individual themselves and what matters to them, and then understanding, collaborating closely with our employer partners to understand their benefits and how they would like specific benefits used so that we can then create sort of curated discovery pathways or data-driven pathways for those individuals. We will then look at what they engage with when they're on platform, and we have the privilege of driving incredibly high engagement, so over 50% engagement on an annualized basis, about 19 touch points a month. And so what that really allows us to do is to give them snackable information on here is something that is probably either going to become important to you shortly or is important to you now, and then help make that into actionable very quickly actionable next steps of what you can do.
(18:32):
So whether that be somebody engaging with, I'm really not sleeping well, I'd love to take a self-curated sleep journey, well, are you aware that you have maybe a benefit that specifically is looking at helping you improve your sleep hygiene or there might be some rewards that you can get that can then help you get maybe a white noisemaker off of the reward website store so that you can then add that to the sleep hygiene that you are trying to create for yourself. So you want to really create a data-driven model that is highly engaging and can really feel personalized to the individual that typically is the best pathway to get a population, not just to engage, but also to take action and actually improve their wellbeing.
Alyssa Place (19:25):
And you're really hitting on that point that all of these benefits are probably available to employees. They have perhaps an HSA store where they can get these benefits, but they're just not aware of that. And Patrice and Ginger, I'd love to ask you about how you overcome that hurdle of this awareness of what benefits are actually available. You're doing so much work to create these opportunities, but people might not even know that it exists. Is that a common problem for you and how are you solving them?
Patrice Johnson (19:54):
Sure. I think every benefit professional is still trying to crack that code. How do we get employees to understand their benefits so that they can engage with them? And that's where I think having a personify, having a primary care provider to be that quarterback and direct you to their appropriate resource, that really helps when you're directed to where to go and when to use benefits when they're needed, that helps drive the kind of utilization that you want to see.
Ginger Miller (20:31):
Yeah, it's funny, this is every benefits person's busy time of the year are tax season with open enrollment and we have numerous new benefits available for the upcoming year. It's just overwhelming. It's a lot of noise to people. They think it's great, it's a great benefits package, but at the time they don't need a lot of this. They don't need it until they actually need it, and that could be mid-year be next year when it's not in front of them. So I think one of the tricks that we found is making sure that all of our various chronic condition management benefits are out integrated with each one of our vendors. Our EAP understands what our diabetes and tobacco cessation and our GI solution is. Our primary care physicians certainly know everything. We have engagements with the various vendors and the primary care physicians, so they know the benefits just as well as the HR department does, and the benefits team does every app website that they can go to that might have a dashboard.
(21:49):
We have tiles that explain the various benefits. So if they're not thinking about it at the time and they're just trying to navigate themselves through the UTS benefits somewhere along the line, they're going to trip upon one of these benefits. But ultimately the term navigation advocate coach, all of those people, I think we used the word quarterback, are there to help people navigate them. But our physicians for sure are the point people are those quarterbacks that when someone comes to them and has an issue with asthma and they're overweight and they're frustrated that they can point to the various solutions that we have in place to address all of these things. So I think integration with all the benefits and just having multiple touch points, multiple forms of communication and just making sure it's not just a once a year effort that we have in place.
Jeff Jacques (22:49):
I'd love to comment really quickly on those two approaches. You need about a thousand co-located employees to make an onsite clinic sort of have an ROI and create fungible value for the enterprise. So I think that what Patrice and MGM have done and having that network of providers that work so closely with their employees is really a brilliant way to work around that co-located number to make it work. But it's highly unusual, I just want to use that word. As an internal medicine physician, it's highly unusual for physicians to actually know about being able to direct individuals to specific programs like you have a great diabetes program that you don't know about, go use that. There was a study done by an employer, I think it was Goodyear Tires, an analysis of the stickiness of a physician saying you would really benefit from this disease management program and saying, go to that phone over there in the corner and call up the program.
(23:53):
And the stickiness was like 92% of employees actually picked up the phone and made the call, and there was 86% persistence at the end of six months. So having a highly trusted individual with a relationship, whether it be the coaches, Patrice that you have on site or that physician ginger that you have on site for your headquarters is really critical as a fungible asset to really drive that. It's often though in distributed workforces, it's often difficult to be able to do that, and so you have to find other ways to make that impactful and really drive that kind of value.
Alyssa Place (24:35):
Yeah, I mean, it just makes me think about my own human behavior. I'm not going, I sleep fine, so I'm not really going to research a sleep benefit until I haven't slept for six days or something. So I can understand the challenge that you all face of trying to get ahead of problems that employees don't even know that they have yet. So I think it's just there's really that sort of a personal psychology element that makes all of your jobs so interesting. And I wanted to ask about that aligned with the data that you have and how you're using data to make those decisions, obviously Dr. Jeff, that's really what you're doing with Personify, but ginger and infantries, how are you doing that at your organizations if you might not have the same sort of data power that Personify has?
Patrice Johnson (25:26):
We heavily rely on our data warehouse. You can pull such critical data out of the data warehouse such as social determinants of health data, things that might not necessarily appear in health claims. And so we're able to take some of that and address populations that may have more specific needs by targeted communications or being more thoughtful about how we communicate in certain different areas. Also looking at employees and how they're trending if someone is trending towards a high cost claimant and just being more aware of what's in your data. I think having that data warehouse available and it's critical so that you can make better informed decisions as you build out your benefit strategy, making sure that we are offering benefits that are relevant and are actually going to make an impact on our trend.
Ginger Miller (26:37):
Yeah, I would agree. Having that data warehouse is very impactful, having multiple sources of information, not just your medical and your pharmacy claims, but there's some of your more demographic information that's coming. It could be your work comp information coming through. You can see a lot of symmetries there on chronic conditions impacting work-related injuries. We just have our point solutions feed information into our data warehouse and then we find out where there are those symmetries within that data. Also, it doesn't hurt to continue to push our point solution vendors and our carriers to give us more, not just we review claims details, that's data. We review case management information on high cost claimants. We look at a high cost claim reviews. We try to understand, we try to ask questions and look at where some of these high cost claimants may be a diagnosis, but they don't really, the more you dig into it and look at some of the claims beyond that diagnosis or a hospitalization, you find that, oh wow, they were treated in the past for some tobacco related issue or some obesity issue.
(28:00):
We have that information. Of course this year we did an employee survey, so that's a piece of data. Also getting feedback on what people are interested in, understanding the point solutions that they're interested in can give you a little bit of information as well on what they're concerned about with their health. So I think looking at multiple sources is important of data, everything from subjective to integration from various solutions. And then lastly, I would say I'm in a not unique role for hr, but we're a mid-size employer, so I manage the leave management absence management. So another data point is what are people going out on FML for on family medical leave for what are they needing accommodations for? So there's another point that we pull together with everything else and look at that on a regular basis as we set our strategy and determine which solutions we want to put in place or which campaigns, communication campaigns we want to implement during the year.
Patrice Johnson (29:06):
Something that you said, ginger that I think is really key is listening to what the employees value. We just launched our first total rewards listening strategy, and I think as HR professionals we can say all day that we think we know what our employees need, but actually asking them and seeing what it is that they value and where there are gaps, and then incorporating that into your strategy and how you determine your benefits offering is critical.
Alyssa Place (29:40):
And I love to know what that looks like in terms of when you say this was a success, how are you defining and measuring success in your programs? Is it really just about, oh, this person had a chronic condition and now they don't? Is it, oh, this employee was going to quit and now they're not going to? How are you all measuring the success of the programs and the data that you're using to really say, oh, we're moving in the right direction here?
Ginger Miller (30:08):
I say there's a variety of ways. Ultimately, we love to see the healthcare costs in general decreasing, and we see that in certain areas, but that can be inconsistent. We look at our point solution engagement, how many individuals are engaging in the various solutions that we have, and then we get data based on that. What do those vendors tell us about the successes from individuals that are participating? We look at cohorts of people. My favorite is looking at the onsite clinic cohort where there's the brick and mortar onsite clinic and seeing what the people that engage in our brick and mortar onsite clinic with their healthcare costs look like versus the rest of the organization that does not have that brick and mortar solution. And we find a real decline in healthcare costs. I found that over the years from participation just with those primary health providers, that's made a huge difference for us.
(31:14):
So there's a variety of ways that we look at success. We look at per person per month or costs going down medical pharmacy costs. But I think also we look at our disease categories, less people in different disease categories, so a multiple different areas that we look for that success. Not as much feedback from employees, each point solution, we do surveys, but surveys are hard to get feedback on to really understand what people's sentiment is about participation, what those point solutions are offering, but we try to pull a little bit of that in as well.
Patrice Johnson (31:56):
Similarly, I would say the same, we'll use the results of the total rewards survey as kind of our baseline, and we will continue to track and measure over time the employee sentiment, but also focusing really on those hard dollar savings. Any point solution right now that we're putting in place, we need to see hard dollar ROI savings.
Alyssa Place (32:22):
And Dr. Jeff, I'd love to hear your metric of success for when you're working with employers. I've done many stories before on curing certain diseases and health is not necessarily the metric that they're striving for. So I'd love to hear from your perspective, what is that metric?
Jeff Jacques (32:42):
Yeah, I've always spoken about this ROI and there's VOI, and so ROI is return on investment. So you want to see some multiple of dollars spent coming back to the enterprise. At least CFOs typically for some reason want to hear that. And I don't know why. And A VOI is sort of like a sandwich that includes engagement and imputed savings from avoiding things that could happen downstream and putting those things together to demonstrate that there's a value creation for a specific employer. If we have claims, we love to run claims analysis. And we've done that and found significant decreases on engaged populations versus non-engaged controls when you engage an individual in their health and wellbeing and make it personal and highly targeted. For example, let's help somebody in ginger's org really look at migraine and how they can use biofeedback to decrease severity or recognize that they're about to have one and maybe use some prophylactic medication to avoid going into a frank attack as somebody who gets a migraine once a year, ginger, I sympathize, or how to help somebody who has developed maybe the first sign or symptom of an MSK issue on how they can try to reverse that from becoming a chronic problem.
(34:19):
So it's highly individualized to the employer. And typically the dividing line will be, do we have claims or not? The more data we have, the better. If we don't have claims, then we have to use imputed models and sit down and walk them through. A lot of the discussions that I've had recently is on what to do about GLP ones and is there a way to avoid having to have large populations on GLP ones? And I think we're going to talk about GLP ones in a little more detail shortly, but GLP ones have become sort of like the staples easy button for large swaths of the populace. And due to their costs and non-trivial side effect profiles, we really have to get creative and figure out how we make sure that the right individuals get access and do they even truly need them? Can you help them build other habits and skills that actually avoid the GLP ones completely?
Alyssa Place (35:23):
And Ginger, I think that's especially pertinent for you. I mean, when we were preparing for this call, we had discussed this, and obviously this is just a huge trend for any organization, but your organization actually made decisions on what to cover and what not to cover anymore. So can you talk me through that conversation about GLP ones, what you decided and what you're offering as sort of lifestyle and other alternatives instead?
Ginger Miller (35:48):
Yeah, I think not unlike other employers, we suffered through that trend that trending of use of GLP for everything, particularly weight loss and questioning whether or they always, the guidelines can be a little loose sometimes when it comes to obesity types of things, but the spend was trending a direction that was really unsustainable. It impacted our health plan. It impacted not just the people that were using it, but everybody, the cost for a medication impacts everyone and their premiums. So after a lot of research and understanding what the health plans we're doing, the fully insured health plans were doing, we as a self-insured employer did decide to remove them just for the anti-obesity. But that wasn't just a quick business decision. It came with a lot of consideration and care. We continued to use them for chronic conditions, allow them for diabetes, sleep apnea, cardiovascular disease.
(36:59):
But when it comes to the weight management, we've really pushed participation in our onsite clinic and various ways to coach individuals through those primary care providers on weight management. We put in a weight management program so that we had that in place, various steps and weigh-ins and accountability. We made all of our point solution vendors aware of the decisions, so they also could put their best foot forward on the solutions that they had internally, whether it was a pharmacy advocacy program that we have, whether it was our diabetes management program that we had, whether it was our mental health provider, they were all aware and ready to speak to, whether it was the behaviors around it coping or just better strategies, very much leveraged all of our healthy lifestyle programs, our gyms, we have onsite gym, we have gym discount programs, some opportunities for nutrition education. So we very much leveraged those and pushed those a little bit harder and had our primary care docs ready to support and take weight loss in a different direction when we made the decision.
Alyssa Place (38:19):
Yeah, and I think this conversation around medication and pharmaceuticals has certainly been top of mind. I think really pushed by the popularity of the GLP ones as a drug. And Jeff, I would love to ask from the clinical perspective, how can employers like Ginger and Patrice balance access to these drugs with really having it be sustainable for their company's bottom line? And is that possible right now?
Jeff Jacques (38:44):
Yeah, I mean, the short answer to your last part of your question is yes, it is possible. It takes some work. You have to work closely with point solutions and with your health plan and PBM to figure out how do you make sure that only the right individuals are getting access. If you're going to keep the GLP ones on formulary for specific conditions, make sure that folks who don't have a condition aren't getting, say ozempic or something else just because they want to drive a weight management issue. I think you need to have something in place to help individuals with weight management challenges, learn or relearn, I should say, how to treat their body and how to engage in a higher physical activity and eating better quality calories and being aware, quite honestly, the number matters. I was looking at something with one of my children on YouTube and the size of the Big Mac and the calories of the french fries and the size of what's a small and what's a large now, these things have really changed over time and not necessarily to our benefit.
(40:01):
So I think you need to create awareness in the individuals that you enroll in these programs, and then they need to be coached through gaining new skills and habits, and that takes time. So I think you need to be thoughtful about how you develop these programs and put them in place, what you make available, and then you really need to look at the results. Are you able to drive a significant loss in weight? A 5% decrease in body weight will actually take you from pre-diabetic to normal. We're not talking about, that's not a huge number. That's not an unattainable number. So there are things that you can do there. And we've seen in some of our own programs, individuals lost 18% of body weight just with just a program with no GLP ones. They were offered GLP ones and didn't really love the idea of an injection.
(40:57):
But I think the bad news is that because GLP ones really address inflammation very well, you're going to see the other conditions. There will be GLP ones expressly formulated for other conditions either as a primary or secondary line of treatment, and that is going to change the rubric. Again, if you can stop somebody from going into liver failure needing a transplant by giving them a GLP one that's going to have an impact. There's data on kidney disease, ginger that's coming along. Some of those individuals who could go over into needing dialysis, potentially you can avoid that cancer data. So I think it's the tip of the iceberg, quite honestly, when it comes to GLP ones and other peptides like them. My, I head up a science advisory board for our company, and we are now doing an entire sort of bit of research over about 90 days on longevity and peptides like the GLP ones. So we'll have more to talk about in a couple in maybe a month or two. But it's really early days when it comes to those kinds of compounds.
Alyssa Place (42:12):
Yeah, it's so interesting, and I want to start wrapping up our conversation by doing a bit of a look ahead. I mean, we're surprisingly in Q4 already. I mean, I'm sure you all are thinking about next year or have already thought about next year. We're talking about some of these advancements in medication and you don't really know what sort of trends are going to emerge, but looking at your own employee demographics and what is on your docket for next year, what's one area where you're seeing the biggest opportunity for improvement or innovation when it comes to managing some of the chronic conditions that you are dealing with day to day?
Patrice Johnson (42:47):
So for us, we've heard that there's really a need to better support our caregiving population. That group is dealing with so many things from mental health to chronic condition management. And so looking at how we can, we already have so many programs in place, but helping it better resonate with employees how these programs can not only just help the employee, but also the members of their family. So that is going to be a significant priority for us in 2026.
Ginger Miller (43:26):
I have to say, it was an interesting comment that glp, what else helps people lose that significant amount of weight? And I sat here thinking, well, our beginning of the year Shape Up US program does because everybody gets together as a community and holds each other accountable for losing weight. So to that point, caregiving, it's a family situation. Chronic conditions are a family situation. So if you can bring communities together and drive change and hold each other accountable, that can really make a difference with chronic conditions. But one other thing that we've added as well is our GI Point solution this year that we're adding on. So I mentioned that's definitely a chronic condition, so we look forward to that. That's a little bit something we hadn't thought about in the past, but when we saw the claims growing in that area, that includes some testing, microbiome testing, that includes some coaching that includes the nutrition counseling. So we're trying not to throw just a bunch of spaghetti against the wall and put various point solutions in, but make them relevant and really address some of the more prevalent ones.
Alyssa Place (44:48):
Dr. Jeff, did you have anything else? You spoke, I'm really kind of blown away at all the medical advancements. Is there anything else that you really see as innovative for the coming year?
Jeff Jacques (45:00):
I think that increasingly caregiving has come up as an issue that individuals are looking at. I don't know if you know the data, but if you are a caregiver and you spend at least 10 hours a week caregiving your likelihood of hypertension, diabetes, and pulmonary disease, all go up, weight goes up. I wasn't available during our prep because my eldest who turns 15 in a few weeks need a scoliosis surgery. So I haven't had a lot of sleep in the last couple of weeks. So I think caregiving is critical. And just to give numbers, 60 million Americans need caregiving, 80 million of us largely women, largely people of color care for loved ones in an unpaid capacity. So you're talking about probably the entire employed population of the United States just to sort of put a number to it. So I think a very big issue that doesn't get addressed, and we don't have national federal policies for caregiving either.
(46:04):
I think. So from an innovation perspective, whole Person Health is really, I think where it's at. It is pulling together the programs and the capabilities that these two brilliant benefit leaders have put in place and really making it a whole cohesive fabric. You don't need to be in all parts of the fabric at all the time, but you need to be able to get guided to the right place in the right time when you need it so that it's not depending on, did you really read that EOB? Do you have a copy of it lying around? Do you know to look it up when you're in the middle of something trying to put out a fire. So anything that we can do that leverages human expertise and technology to get individuals to the right place, the right point solution, the right capability, I think that that's really going to be where we start turning the needle on rising healthcare costs and pushing back against them.
Alyssa Place (47:04):
Yeah, I mean, unfortunately, I don't think healthcare costs are going to be reduced anytime soon. So just to sort of wrap up, I would love to hear your piece of advice, even if it's just a psychological pep talk that you can get through this next round, but what would you say to other benefit managers who are looking at their budgets and just saying it's not going to add up? What's your one piece to calm the storm a little bit?
Jeff Jacques (47:30):
Box breathing.
Alyssa Place (47:32):
Yeah, box breathing, breathe. That's great.
Patrice Johnson (47:38):
I would say to really lean on our benefits peers, no one has really figured this thing out, but collectively, the more that we talk with one another about what's working within our unique populations, I think that really helps know what's out there to even offer as a solution, what not to waste our time on. So I think it's really important for us to lean on one another.
Ginger Miller (48:04):
Yeah, I often listen to webinars from large employers, and I have a lot of small employers sitting in the audiences that are thinking these large employers are able to put onsite clinics in and put point solutions in, and I don't have that budget to do that. My advice is use what data you can get your hands on, ask question, look around at the free resources that are out there, the various chronic condition organizations offer loads of toolkits and resources for people. Use your local doctors and providers and partners because they can come in and they can be great partners, and it doesn't hurt because they like to drive business their way also. So they'll often offer them to employers and model things from the leaders, let the leaders walk the walk and make sure that they're giving those pep talks and showing that they're going out and doing things and living healthy lifestyles and giving people the opportunity to do that during their long work days as much as possible. So I think the small things, whether you're smaller or larger, there's all types of solutions that can be scaled according to the needs, but you have to also be really keep your eye on the ball on what do you need? What are the issues at the foundation?
Jeff Jacques (49:37):
I know of a great innovative TPA that can bundle awesome point solutions into its offerings. If anybody wants to hit me up on LinkedIn, I would say that my advice to benefit leaders is to find partners and create accountability and make sure that there is a thoughtful approach to benefit balancing. You're often managing multiple generations. What matters to a genzer is different to an Xer, to a boomer or a sign generation individual or a millennial. I don't want to leave anybody out. And so really, you have to be mindful about what matters to them. I've heard in my discussions over 20 years with benefit leaders, if you bring something out that appears only to impact, let's say the Zs and millennials, then the Xers and your boomers and silent generation folks get very upset like, we're not doing that anymore. Why isn't that? What about us? Kind of thing. So I think really having a mindfulness towards benefit balancing and partners that can help get individuals to the right place in the right time is really critical so that it feels, again, this is part of corporate culture, so you really want whomever's helping you with some navigating to those benefits, those solutions is really baked into how you see your corporate culture, what you're trying to promulgate, and the fact that you care about your employees and want them to thrive as they progress in their work life with you.
Alyssa Place (51:11):
Well, great. Thank you all so much. You certainly have your hands full, but we really appreciate the time that you've given to share your insights and your expertise. Again, I'm Alyssa Place, editor in chief of Employee Benefit News, and thank you so much to Patrice Johnson, ginger Miller, and Dr. Jeff Jock. Thank you all again. And that concludes our session today.
