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Businesses shifting to work with health care reform

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The new health care regulations do more to create access than to lower costs, so local business leaders said they are looking for more innovative ways to lower costs on their own.

At a recent Daily Transcript roundtable discussion, business leaders said many of the details of the new health care reform bill remain unclear so in crafting benefits programs, employers are relying on one thing that is clear: people will get sick. This means attempting to identify who will get sick and therefore cost a company health plan the most money. This can lead to some thorny legal areas, but can also lead to great innovation in the private sector.

"We're not sure that what got enacted is going to do anything to change the health and the healthy habits of the work force, which is the number one driver that is causing many of the need for health insurance reform," said Jeff Lindeman, director of human resources for the San Diego County Regional Airport Authority.

"We're locked in on our health care premiums through 2011, so it's indeterminate for us what the short-term or long-term impact (of health reform) is going to be," he added.

There may not be a noticeable economic impact yet, but most companies are resigned to the fact that their health care costs are going to go up. Wayne Hickey, chief executive of Roel Construction expects the impact sometime in the middle of next year. This is making some companies more tuned in than ever over their employees' health, going beyond the usual exercise programs and healthier food in the vending machines.

Intercare Insurance Solutions has hired three law firms to help the insurance brokerage and consulting company navigate the new health care act and help its clients make a plan to go forward, the company's President and CEO Mike Barone said.

"If you're trying to help a client develop a three-year benefit strategy to reduce health care costs through … cost shifting, or corporate wellness programs, or consumer health care driven plans, if you have more insight into what's going to change with respect to those laws over a three-year period, then you have a better chance of executing your strategy more successfully than to do it episodically," Barone said.

"We find ourselves spending a lot of time trying to figure out not only what is and has been passed, but what will and what that impact will be," he added.

Some of this strategy can be finding new incentives for employees to live healthy. Lindeman said the Airport Authority has exercise programs, but the agency noticed most people who participated were the kind of people who already went to the gym on their own. Employees who most needed a workout weren't taking advantage. He said they've had to learn better ways of getting their message across, and to mix up the use of so-called "carrots and sticks," or rewards and punishments.

"Businesses think that carrot-and-stick is what motivates people. Science will tell us that that's not what motivates people," Lindeman said. "If we put all of our energy into what we think is a driver of behavior, be careful."

That has meant, for example, encouraging people to do any kind of physical activity for 30 minutes, not just old fashioned exercising.

Other methods companies are employing are innovations like the Well Being Index, a data source created by the pollsters Gallup and the company Healthways. John Kahle, chief wellness officer of Intercare Insurance Solutions, explained the Well Being Index as a measure of a population's engagement, meaning how involved they are with their work, finances and community around them. The more engaged people are, the index says, the healthier they are.

A person can use this index to gauge the well-being of people within a ZIP code, congressional district, state, or basically any population. Employers can use it by seeing where their employees live.

"So now, as an employer, how do you change engagement?" Kahle asked.

Part of changing engagement, employers said, is getting personal with employees. That can be positive -- such as helping to identify stressors that might be causing them to live less healthy lives, but can also mean pointing out problems people are sensitive about, like weight. For example, companies might create a tiered health care system wherein smokers pay more, or people can be charged for not treating their diabetes correctly.

This could potentially lead to lawsuits over privacy and discrimination, but Kahle said companies should still consider it.

Joseph Smith, a doctor turned chief medical and science officer for the West Wireless Health Institute, said he thinks that could ultimately be the most positive result of health care reform: it will force the system to change.

"I view it as a positive nudge toward a very important time for change," Smith said. "As opposed to necessarily moving toward the solution, it's driving the levers toward creating a solution."

* Video: Interview with Joseph Smith, John Kahle


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