Health care costs continue to soar. Employers are looking for ways to combat these increases that don’t send employees looking for another job or scrambling to make up the difference.

The Alliance is a cooperative of employers taking this challenge on by strategizing ways to make the most of available resources or incorporating new ideas. Corporate Report Wisconsin spoke with five companies who shared stories at The Alliance Annual Seminar earlier this year and asked them what they are doing to keep employees happy and CEOs smiling.

Quad/Graphics

Location: Sussex
What is your company doing to reduce health care costs?
“We’ve recreated a mini-health care system for our parent company and a handful of other clients,” says Ray Zastrow, chief medical officer of QuadMed, a subsidiary of Quad/Graphics. “I like to refer to it as an empowered model of primary care.”

This model encompasses the principle of investing in primary care and actively managing chronic conditions to see savings in cost and improvement in the overall health of employees. “We do spend more on our primary care, but the downstream savings are dramatic,” Zastrow explains.

With a network of five on-site clinics serving three major corporations, QuadMed sees the benefit of building relationships with employees, especially through chronic condition management. The clinics offer a number of incentives for employers and employees alike. When following an established program, diabetics, for example, receive an enhanced benefit on their necessary supplies as well as coaching from a certified diabetic educator.

Zastrow explains that on-site clinics offer a place for employees to address their health care needs, first. People don’t go to the emergency room nearly as much because “they have superior access during the day right on-site at their workplace.”

What works?
With QuadMed, Quad/Graphics has had great success through collaboration with other local businesses; MillerCoors, Quad/Graphics, and Briggs and Stratton all share five clinics located around the area. An employee or family member can go to any clinic, whether or not it’s their “home” location.
Access to multiple locations is well liked by employees, too. “We leave big chunks of time open every day and come to work with maybe 30 percent booked,” explains Zastrow. “Not only do people like that, but they’re not running to the emergency room [as often].”

It’s a LEAN principle that is not adopted regularly by health care providers, but works in this setting and has a great return on investment and saves time and end cost.

What doesn’t work?
Zastrow quotes Albert Einstein’s definition of insanity: Doing the same thing over and over again expecting a different result. In this setting, he relates it to “continuing to try to buy health care without being creative and leveraging one’s purchasing power.” He says many may feel daunted by health care and just throw their hands in the air, but “it’s coming back to bite them with double-digit increases in premiums, so clearly that’s not working anymore.”

Advice to others
“Just get started,” says Zastrow. “Find a way to reduce the cost for things that are of prime value. You want people to take it to their primary first.”

Seats Inc.,
Location: Reedsburg
What is your company doing to reduce health care costs?
“One of the things that has been consistent over the years is our membership in The Alliance,” explains Jerry Ward, vice president of operations at Seats, Inc. “We think it’s important to know where we’re spending our health-care dollars and the areas that may need some attention.”

Seats Inc. has been self-funded since 1982 and has spent many years evaluating cost and making tough decisions on how to direct its health plan. “We’ve done much over the years to look at every cost and if it’s something that doesn’t provide what we see as a value, then we try to remove that cost,” Ward explains.

Today, the on-site clinic boasts a full-time nurse and two doctors, each in the office one day a week. One of the physicians is a retired surgeon and able to perform minor procedures. A chiropractor comes on site, as does a massage therapist and physical therapist.

“We make those services available to our employees and their immediate families whether they carry our health insurance or not,” says Ward. “It’s been a really significant benefit and also, I believe, a correlation to increase in productivity.”
The company also offers a direct cost benefit to employee premiums if the company’s costs rise or fall. Uniquely, the company looks at the recent year only to determine the impact, which is very responsive. “When costs go down, we lower the employee’s premium,” explains Ward. “It’s not like we say, ‘Oh, that was a good year, we’re going to bank it.’ This allows us to stand in front of our employees and explain that whatever we do, if it results in a positive impact, they’re going to see the benefit.”

What works?
The No. 1 thing Ward recommends and believes in is communication. Talking with employees about changes and incentives through meetings, employee rap sessions and open communication about provider experiences is common at Seats, Ward explains.

What doesn’t work?
Ward wouldn’t say that these things don’t work for health care management, but that they are things Seats has chosen not to incorporate.

The first, is large case management or pre-certification, something it has never done; the second is using a broker. For many years, the company did employ a broker, but when they parted ways, the third-party administrator, Auxiant (Alliance Benefit Medical Group LLC) provided in many cases, the same level of information. To avoid “missing something,” Ward and others participate in local organizations and educational sessions to keep abreast of what’s happening in the health care industry.

Advice to others
Good data is something every employer must have, Ward says. When Seats went to a self-insured model, it was facing a 53-percent increase in premiums and never knew what its real health care “experience” was. “We always have suspected the insurance companies thought it was bad,” Ward says. “At least now we know what our experience is and where the cost drivers are.”

Miniature Precision 
Components (MPC)
Location: Walworth
What is your company doing to reduce health care costs?
MPC is using Health Risk Assessments (HRA) to make its on-site clinic friendlier to its employees by focusing on wellness and prevention, says Janette Berry, benefits administrator.

A nurse practitioner is on staff as well as a medical assistant. Berry says the nurse takes the time to understand what’s driving a person’s individual issues, as well as coach them when faced with a specific problem or even simple wellness concerns.
The clinic is managed by a third-party vendor, which also partners to assist with the company’s wellness programs, including weight management classes, walking and biking groups and lunch-and-learn sessions. An internal wellness committee sets and drives the programs, explains Berry.

MPC has implemented a points system that is directly linked to receiving a discounted insurance premium rate the next year. Things like dental exams, eye checkups, annual physicals and aerobic exercise are ways employees can earn points.

“Prevention is what we’re trying to drive,” explains Berry.

Working to build trust with spouses is very important as well. Many times spouses and dependents drive medical decisions for the family. “We want them to understand the different ways they can utilize the clinic.”

What works?
“Each year we build on what we did in prior years,” which she explains is a best practice.

The HRA program has always been voluntary but is now more involved. Originally, the HRAs were paper, but now they are Internet-based and include biometrics taken from blood draws, which employees must complete in order to receive an insurance premium incentive. The biometrics offer insight into glucose and cholesterol levels, among other health indicators.

The clinic staff goes over the results at a separate appointment, which “gives them the opportunity to immediately coach,” explains Berry.

What doesn’t work?
Berry advises companies to use the HRA data to coach and engage employees in their health decisions. She said that previously the results were posted, but no programs or initiatives were driven toward those results. “That passive behavior by the company didn’t drive any changes in employee behaviors,” she explains. “It brought some awareness for folks but didn’t improve any of our numbers or help reduce big-dollar claims.”

Advice to others
Focus on prevention. “It’s not going to happen overnight, but get in front of employees and get them to start thinking about it,” Berry says. Employees, she says, are thankful they found out about symptoms like high blood sugar or cholesterol that may have prevented larger issues in the future.

Berry says she knows that her company went through the same struggles as many others. “We were thinking that this is a big upfront cost, what will the ROI be,” she says. “We’ve only had a small ROI so far, but we’re going to start seeing money saved on health plans and also see employees making healthier decisions.”

Webcrafters
Location: Madison
What is your company doing to reduce health care costs?
Judy Peirick, Webcrafters’ vice president of human resources, says The Alliance, of which the company is a founding member, has been an integral part of the company’s strategy in managing health care costs.

As a self-funded organization, Peirick says the company has to “get up to our elbows” in the insurance discussions. “If you really want to try and manage your costs in this area, provide a high level of benefit and continue to offer that, you have to kind of roll up your sleeves.”

One of the most unique parts of Webcrafters’ program is the ability for those with chronic health conditions to receive free prescriptions.

Employees and/or spouses work with condition management staff, and if they agree to be actively involved in managing the condition (attend appointments, take medications, get necessary screenings, etc.), the company pays for their meds. Some people are completely on top of their care, and others need more coaxing, which is where the third-party vendor’s nursing staff comes in. They are great with reminders, following up and one-on-one coaching, explains Peirick.

And, “it’s a great investment,” she adds. “It’s the right thing to do because the people who are eligible for the program are those who need their care managed and you don’t want any barriers, like the cost of a prescription, to get in the way of that.”

Webcrafters also utilizes HRAs (every other year) and requires biometric tests, saying paper exams are only as accurate as the person filling it out wants it to be.

She says it’s important to not ignore spouses in this equation, because many times more than half the cost of an employer’s cost is due to dependents. Both employee and spouse must participate in the HRA to receive the premium discount.

Benefits such as acupuncture and chiropractic are also very popular with this stable employee population.

What works?
Now at 94-percent participation, the HRA offers a great incentive for employees to save money on their own premium dollars.

Communication is key, however, to getting employees on board and understanding that in a self-funded environment in particular, what they do matters.

What doesn’t work?
A lesson learned was with the smoking cessation program. This was the first initiative, which offered reimbursement for smoking cessation programs and products. “We didn’t create enough of a supportive environment or make it more difficult, quite honestly, for people to smoke during work,” Peirick explains. Since then, the smoking cessation programs have been offered on-site during work hours and have become very popular. In addition, employees now receive discounted premiums when they pass a nicotine test for a specific amount of time.

Advice to others
Peirick advises companies to have a longer-term plan. “You can’t go from not having health risk assessments to laying this in with a stick,” she says. “Incentives work better than a stick, always.”

“There are certain things we can’t control, but let’s control the things we can,” she adds. “I feel we need to help our employees; sometimes it’s creating incentives they may not even like that much, but then they learn something about themselves.”

Monroe Clinic
Location: Monroe
What is your company doing to reduce health care costs?
Monroe Clinic has taken its wellness plan to a new level by designing a points-based benefit plan. Each staff member who receives 100 points by the end of the plan year is eligible for a deduction on the next year’s insurance costs.

Only a certain number of points can be earned each month, which requires a year-long engagement on the employee’s part, explains Dr. Mark Thompson, chief medical officer at the clinic. Exercise, health screenings, dental exams, flu shots, mammograms, colonoscopies and all other routine exams count toward the goal.

Personal coaching through the clinic’s wellness programs is applicable, as is choosing the health option on “Wellness Wednesdays” in the cafeteria.

“I consider it success when I leave the building and there’s a Zumba class going on in one of our lecture halls, and there are nurses, physicians and maintenance staff all working out together at five o’clock,” says Thompson.

What works?
“If you want to invest in prevention and primary care, then you really have to design your benefits plans to result in the desired healthy behaviors and access to preventative care that leads to improved health and value for your employees,” Thompson says. He explains that out of the gate, these decisions may not be popular, but your leadership team must be committed to doing so.

“It was a really easy conversation to have with our employees,” he says. “This plan is all of ours, as our health plan is a group benefit. We all have to work together to improve our population’s health, so our costs are controlled for all of us.”

What doesn’t work?
Thompson believes that a collaborative environment hasn’t always existed between the provider community and the employer community, but “the reality is that it’s all of our responsibility.”

Advice to others
He suggests others begin pursuing different health care options by openly talking to local providers and asking them what incentives they are using with their own employees. Is it working, and if so, “asking if you can do similar things in your own organization,” Thompson notes. “That’s a starting point. When employers and health care systems partner, they will get the ultimate return of health in the workplace and community.”

He also says that employers must recognize that there is a certain level of risk that must be taken when stepping out of the current system. “Like everything else, creating value-based benefit design in providing preventative health services requires thinking outside the box,” Thompson notes. 

By Jen Bradley

Jen Bradley is a freelance writer living in East Troy.

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