In 2002, the most expensive health conditions were heart disease, cancer, trauma, mental disorders and pulmonary conditions. These conditions plague employers, and last week, leaders in business met to discuss ways to manage them affectively to not only get a healthier workforce, but a more cost-efficient one.
At Delta Air Lines, 25% of the high-cost claimant expenses and 16% of overall health plans cost comes from cancer. Employees at Delta spend an average 17 years with the company with an average age of 47.8, which means that employees can sometimes spend a large chunk of their careers there. It was imperative to the airline’s executives to create solutions to deal with the growing pool of workers being diagnosed with the condition.
Lynn Zonakis, managing director of health strategy and resources at Delta said the company has rolled out three versions of its cancer program in the past 10 years, the first being a “center of excellence” program in partnership with OptumHealth.
“The reality is that most people get treatment locally, so we wanted some program that would reach the rest of people,” she said at last week’s National Business Group on Health conference in Washington, D.C. Delta covered 100% travel and lodging expenses and after the deductible is reached, it pays the entire medical bill. The only problem, however, was that employees sometimes were reluctant to possibly travel across the country to get care. So, version two of the program featured a boutique cancer vendor, but there wasn’t much utilization. The last installment, version three, is a telephonic case management program. When employees receive a diagnosis, they can call a hotline to be connected to a nurse who works with a local doctor.
“The focus is on trying to get people early on and getting a good care plan created,” Zonakis said. “The interesting thing I’ve heard from employees is that they give patients as much time as they need and have regular contact, particularly early on.” The program also encourages patients to get a second opinion once they are diagnosed, which Delta pays for. It had low utilization in the first two years, but as word spread about the program, more people have used it. In addition, the company has introduced drug management, psychosocial and work-life supports.
PepsiCo, Inc. has taken a similar approach. It has several disease management vendors, which can be a lot for employees to manage on their own, but recently senior leadership brought on a health navigator to integrate each vendor and direct all phone calls to one line.
Bruce Monte, senior director of health and welfare plans at PepsiCo, recently introduced a travel surgery benefit with Johns Hopkins to provide employees access to cardiac procedures and joint surgeries. PepsiCo pays for travel, accommodations, meals and expenses, plus the cost of care once any deductibles are reached.
“Like everyone else here, we have the same performance that you do, so there is a real imperative to do what we can to mange it.”
Another fairly new program is “CareConnect,” a multiple-employer patient-centered medical home pilot based in Dallas. Because PepsiCo is spread out across the country, they needed something that could meet each population’s individual needs.
“In some ways, we have 100,000 employees, but when it comes to health care we’re not a large employer. We’re a small to medium employer in a bunch of places,” Monte said. So, it’s partnered with other employers in regions to identify its sickest members. Though the program is fairly new, 40% of contacted employees have agreed to participate. Employees receive an introductory postcard in the mail notifying them to expect a phone call, then consultants encourage them to participate the program. One of the onboarding challenges is that employees must stop seeing their home doctor to participate. However, Monte said that obstacle often is overcome by the level of case management and care patients receive from the program. In addition, the primary care physician fee is waived.
“In a case like this, free actually does sell. You’ll see the doctor more, but it won’t cost you more, it’ll cost you less. Given nature of these folks, they’re going to hit the deductible, so those office visits don’t cost the company much,” he said. The model focuses on a “patient-centered approach” and once employees call for help, they’re guaranteed a callback within 15 minutes, which has equaled decreased ER usage.
Though Monte didn’t yet have data on the return-on-investment, he did say both programs have seen good results thus far. Zonakis said they’ve seen ROI of 2:1, but like most programs, measuring success can be hard, especially with chronic cases.
“The impact on lives has been profound. In my job, I often hear complaints, but maybe 12 times a year I’ll hear a ‘thank you’ on various things and the most heartfelt are the ones in this program,” she said. She said there is still more work to be done in exploring the best treatments and in how treatment should be paid for. “Companies like us are going to be pressing experts and health plans to start limiting drug use or requiring rigorous check, because when you look at oncology, it’s all over the board. The focus right now is to press plans and partners to collect data, measure and quantify it, particularly with the cost of treatment.”
