Well, there are few guarantees in the world of employee health, but for corporations truly committed to transforming their approach by leveraging healthcare consumerism, there is mounting evidence of successful outcomes. But the results of others don’t necessarily translate to what is possible within your own company.

Companies adopting consumer-driven health plans, health savings accounts, wellness programs and the array of related support programs also need to work on establishing their own standards and their own metrics for success. What results will be significant enough to continue to support healthcare consumerism in a substantial and meaningful way?

The answer will vary from company to company, but having the tools to actually measure the results will be a key step forward. This article will outline ideas and principles to consider in the ROI planning process.

Measurement begins with objectives

The place to begin is to clearly define the objectives. What specifically are you trying to achieve — by employee segment, by disease area, by investment type, etc.? Some examples could include: reduce the overall cost of certain chronic diseases by a specific metric; increase the defined fitness level of all staff by a particular factor; eliminate all tobacco from the workplace; motivate every single employee to engage in a new wellness or prevention oriented behavior; institute a personal health record for all employees to use proactively. Done with the required amount of detail, this exercise may actually be a new experience for many companies.

Specific objectives can vary widely and incorporate a broad variety of features. What is important is that each should be measurable, because as Peter Drucker has taught us, if you can’t measure it, you can’t manage it.

After defining your objectives, you need to identify just where you are right now. What is the current status of your employee’s health? What are we spending? What do we know about the employee population?

Tons of usable data about your employee population are collected each year by your benefit plan providers. Dig into the quantitative information that is available and supplement it with primary research. Qualitative research done via focus groups or in-depth interviews can yield insights and raise assumptions and hypotheses about potential new directions. Survey a representative sample of the population about their attitudes, behavior and desires. Let this help both establish a benchmark and begin to chart a path forward.

Setting a clear measurement plan

To continue forward, a ROI research methodology needs to be established and budgeted in advance. All too often, marketers in the healthcare area invest in a promotional program and then ask about whether it worked. By establishing a methodology for measurement and pursuing results with rigor both toward statistical analysis and qualitative outcomes, a clearer picture of effectiveness can emerge.

In thinking through the research plan, decide what parameters need to be measured, how to measure them and when to measure them. Use market research professionals to oversee the process, but also consider creating a task force of committed employees to help. The human resources and employee benefits teams need to play a role, but are probably not best suited to lead the research initiatives. A third party such as an outside vendor with an unbiased perspective would be more appropriate.

Next, consider test marketing ideas and approaches. Some ideas and programs are better evaluated with select employee populations as an early indicator of acceptance and outcomes. These can be compared to “control cells” elsewhere in the population. For credible comparison, however, be sure the two groups can be seen as equally representative.

For full population programs, look at longitudinal tracking studies to really understand what may help change behavior, based on the communications and interventions that occur along that time horizon. Use the employee feedback not just for measurement, but also for improvement.

Many companies have adopted principles of Total Quality Management (TQM) in many facets of their infrastructure. Manufacturing, research and development and other high science or quantitative departments often run their operations based on such processes. Employee healthcare should have similar concepts and approaches built in. W. Edwards Deming, the late quality guru, preached continuous improvement. That concept fits well with healthcare.

What, how and when to measure

To the point about what to measure, we know that all investment against employee health should yield an economic impact. Some of that is based on benefits difficult to measure from a health outcome standpoint, such as employee recruitment and retention. Beyond that, the standard econometric approaches to ROI as applied to the selection among various health plans still apply, but are only one dimension of outcome that need to be considered.

The how to measure question can be addressed by first understanding the currently available data points. That will need to be supplemented by the qualitative and quantitative points mentioned above. The proper use of Health Risk Assessments, along with blood draws, weigh-ins and other diagnostic tools can effectively supplement existing data. Add to that the self-reported attitudinal and behavioral measures, and a fairly robust picture should emerge. The real key is to measure aspects of the programs that relate back to the objectives.

An interesting issue is whether to consider new criteria for measurement. At last year’s Partner’s Telemedicine conference in at Harvard Medical School, there was discussion of the concept of “Return on Time Spent.” One of the panelists told of his troubles with the medical system in caring for his ill son. He shared a number of anecdotes about the endless hours he spent in hospitals and at physicians’ offices, often to spend only a matter of minutes with a doctor. Imagine getting back all the lost time an employee unnecessarily spends in dealing with our dysfunctional health system.

The last point is the when to measure question. Taking a benchmark at the beginning and then another measure a year later provides some knowledge, but we would advise a series of measures that could be looked at monthly or at least quarterly. More is better as long as it is relevant and representative.

In the end, few companies will really go “all the way” with such a research plan, but even taking the first step is laudable. When they see all they can learn and how they can adjust their benefits to suit their population, it will be hard to go back.

Author: Frank Hone
Source: ezinearticles.com

1. Contributions can be deducted as a deduction against adjusted gross income for an individual or an employer can make tax deductible contributions on behalf of their employees. Health Savings Accounts also allow both employers and employees to make tax deductible contributions to the employees plan/account.

2. Maximum contributions to a single individual plan may not exceed $3,000 for 2009 (indexed for inflation in subsequent years).

3. Maximum contributions to a family plan may not exceed $5,950 for 2009 (indexed for inflation in subsequent years).

4. Employees age 55 or over may make a $1,000 per year “catch-up” contribution.

5. Single plan deductibles must be at least $1,150 for 2009 (indexed for inflation in subsequent years).

6. Family plan deductibles must be at least $2,300 for 2009 (indexed for inflation in subsequent years).

7. Single plans must cover all out-of-pocket medical expenses in excess of $5,800 for 2009 (indexed for inflation in subsequent years).

8. Family plans must cover all out-of-pocket medical expenses in excess of $11,600 for 2009 (indexed for inflation in subsequent years).

9. Individuals under 59 1/2 may make a once in a lifetime only rollover from a traditional IRA to a Health Savings Account without incurring a 10% penalty or incurring any income tax on the rollover amount. This is particularly beneficial for any individuals nearing retirement. The maximum amount of the rollover may not exceed the maximum allowed contribution for the year. Once this rollover election is made, it is irrevocable.

10. Earnings on HSA plan funds are not subject to current income taxation.

11. Distributions from HSA plans to pay for qualified medical expenses are tax free.

12. Funds not used for the year may be accumulated inside the plan for use in future years.

13. Individuals age 65 or over are ineligible to contribute any more money to their HSA, however, they may use HSA funds to pay for qualified medical expenses not covered by Medicare.

14. Distributions from an HSA must be for qualified medical expenses. Any distributions made for any other reason (called “disqualified distributions”) are subject to income taxation as well as a 10% penalty.

15. Distributions from an HSA for individuals age 65 or older are subject to income tax but are not subject to the 10% penalty for disqualified distributions.

Because money withdrawn from a health savings account to pay medical expenses is tax-free, anyone who has an HSA can funnel all alternative medical expenses through their HSA and get a tax write-off.�This could include biofeedback, naturopathy, Ayurvedic medicine, aromatherapy, magnetic healing, reflexology, and the list goes on.

People who use complementary therapies are often very health conscious, and go to traditional physicians less often.�So it does not make sense for them to be paying a high premium for a traditional health insurance plan with a co-pay, particularly when their medical treatments are not covered anyway.�Instead, many are choosing a low cost high-deductible HSA plan.

Alternative Therapies Becoming Mainstream

Many hospitals are now offering complementary treatments.�The website for the Memorial Sloan-Keating Cancer Center states that complementary therapies are used to “help alleviate stress, reduce pain and anxiety, manage symptoms, and promote a feeling of well-being.”

Some group health insurance plans are beginning to cover more complementary expenses, but there is still very little coverage for these expenses in individual or family plans.�Those that cover chiropractic limit coverage to 12 – 20 visits per year, and a few will cover a limited amount of acupuncture.�But very few if any cover hypnotherapy, Reiki, iridology, or faith healers.

Why Complementary Medicine

The conventional medicine practiced by most MDs is called allopathic medicine.�The philosophy of this system is to treat disease and injury using counteractive methods.�For instance, if you have a fever you may take aspirin to make it go down, if your cholesterol is elevated you may take a statin to reduce it, if you have heartburn you may take an antacid.�The thinking is mostly focused on removing the symptoms of disease, and the primary treatment modalities are surgery and prescription drugs.

But there are other ways to look at things. Naturopathic medicine is based on the belief in the body’s own healing powers, which can be strengthened through the use of certain foods, vitamins, herbs, or other “natural” treatments.�Traditional Chinese Medicine (TCM) is based on ancient Chinese theories about the balance of yin and yang.�Ayurvedic medicine is based on principles of movement, metabolism, and structure.

Part of the growing use of complementary therapies is a reaction to the costs, side effects, and philosophy of conventional allopathic medicine.�Physicians get much of their continuing education from the pharmaceutical industry, and they work in an environment where the insurers and the patients are both looking for a quick fix.�The result is that the average 60 year old is now taking 5 regular medications, yet there is little expectation that those drugs will ever cure the health problems for which they’re being used.�Many consumers see this, and instead are using other methods to try to get to the root of their illness.

What is Considered a “Qualified Expense”

Qualified medical expenses have been partially defined in IRS Publication 502, and through various federal court rulings.�There is no definitive list, but there are really very few restrictions as long as the procedure is for the treatment or prevention of a specific health condition.�For instance, you could not use your HSA funds to pay for a relaxing massage for your own personal pleasure.�But if your doctor recommends you get a massage for specific medical reasons, this is considered a qualified expense.�Yoga would not normally be considered a qualified medical expense, but it would be if it was recommended as a physical therapy following some sort of accident.

Some may question why the government would give a tax deduction for someone to use some crazy energy vibration machine to cure their cancer.�But this is as it should be.�No one but you should be able to decide what type of treatment you will use for your own illnesses.�By empowering individuals to manage their health as they see fit, HSAs encourage personal responsibility and help loosen the monopoly on healthcare that conventional medicine has had for the past few decades.