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Purchasers of Health Care Products
Employers
Lowering Costs Through Integrated Medical and Disability Contracts and Care Delivery Practices that Improve Employee Health
Only one quarter of health-related cost for employers is for actual health
service use. The remainder is for costs associated with lost productivity
and disability expenses (see Table below). Nonetheless, these three components
of employer cost are linked. If employees or their family members are sick,
they become less effective at performing work activities (presenteeism).
If the illness is sufficiently severe/acute or complex, then health service
use and disability ensues. Thus, preventing illness and regaining and/or stabilizing
health is at the core of reversing each of these health-related cost factors. A key to achieving this goal, in this era of health reform is to insure that health care payment procedures facilitate the coordinated delivery of care to employees with health complexity and include effective, collaborative treatment for both medical and mental conditions.
| Contribution of Medical, Disability, and
Presenteeism
Costs for Ten Health Conditions to
Total Employer Health-Related Costs |
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Medical |
Disability |
Presenteeism |
| • Allergy |
11% |
7% |
82% |
| • Arthritis |
14% |
9% |
77% |
| • Asthma |
19% |
9% |
72% |
| • Any cancer |
42% |
5% |
53% |
| • Depression & mental illness |
15% |
14% |
71% |
| • Diabetes |
29% |
9% |
62% |
| • Heart disease |
72% |
9% |
19% |
| • Hypertension |
23% |
14% |
63% |
| • Migraine/headache |
8% |
3% |
89% |
| • Respiratory disorders |
46% |
29% |
25% |
| Average |
27% |
11% |
62% |
| Goetzel et al, JOEM, 46:398-412, 2004 |
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Do these describe your situation...
- The cost of annual health care benefits are rising in excess of profit margin and no end is in sight
- Mental health morbidity is a leading cause of lost productivity and disability yet access to and outcomes from mental condition care is limited
- A small percentage of employees (and their families) with chronic and/or complicated medical and mental conditions drive high health and disability costs
- Delivery of quality health care does not seem to follow health care cost increases
- Dropping health coverage as a benefit for employees has already occurred or is becoming more of a consideration
...if so, Cartesian Solutions, Inc™ assistance provides employers with:
- Specific recommendations about how to lower health and disability costs by improving medical and mental condition outcome after
- An analysis of cost saving opportunities
through review of aggregate employee health and disability claims costs subdivided by medical, mental health, pharmacy,
and disability expenditures;
- An evaluation of representative purchased health-related products, e.g., insurance
benefit descriptions, disability plans, employee assistance services, care management programs;
- A review of Mental Health Parity and Addiction Equity Act of 2008 [MHPAEA]
compliance and payment processes;
- A review of representative
provider contracts, e.g., preferred provider organizations, and of integrated
care delivery capabilities, e.g., patient-centered medical homes (PCMH), accountable
care organizations (ACOs);
- After the above assessment, Cartesian Solutions, Inc.™ provides step by step suggestions that couple payment procedures to improved delivery of services at the provider, rather than the health plan and management vendor level
- Health contract benefit descriptions designed to enhance coordinated care delivery that leads to mental and medical health improvement at lower total cost
- Disability contract benefit descriptions that link management services and facilitate health and productivity
- Care management procedures designed to augment recovery and health stabilization of employees with complex health problems
- Provider contracts that foster use of patient centered medical homes with behavioral health components and promote the principles of accountable care organizations
A critical component of Cartesian Solutions, Inc.™ services to employers
is the development of a structure within which important outcomes for employees
can be measured (see Table below). When possible, Cartesian Solutions, Inc.™ compares outcomes generated through employer databases with those provided by their
health plans or management vendors. This allows verification that performance
measurements of the contacting agents are accurate.
| Employer’s Outcome'Report Requirements |
- Usage Metrics (quarterly)
- Outcome Metrics (quarterly)
- Rolling Medical, Behavioral, and Pharmacy Service Use Averages and
ROIs (quarterly)
- Satisfaction Survey Results (annual)
- High Claims Reports (quarterly—need to be linked to outcome
data)
- Case, Disease, and Utilization Management Enrollment and Outcome
Data
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Once approaches, which support physical and mental condition integration,
have been implemented, Cartesian Solutions, Inc.™ experts can perform
reviews and workflow fidelity audits of the purchased products moving forward.
The potential for health improvement and cost savings through the introduction
of integrated services can run in the millions and even billions of dollars, depending on the size of the employer. Almost any level of integration in
a population of those with health complexity should be associated with a return
on investment. It is important to maximize opportunities through integrated
service support and clinical integration practices so that the health care
service use and cost gap between those with and without mental conditions
and health complexity can progressively close.
For more information or to set up an appointment contact: Mary
Kathol, Director of Project Implementation.
Cartesian Solutions, Inc.™
3004 Foxpoint Rd. - Burnsville, MN 55337
Phone: 952-426-1626 - Fax: 952-426-1200
E-mail: integration@cartesiansolutions.com
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