Escalating health care costs fuel a firestorm of issues for companies struggling to maintain profitability yet offer affordable health insurance to employees and their families.
But ever-increasing health care costs are really just a symptom of a much bigger problem, according Tom Revels, a health care executive with 17 years’ experience in hospital management, including serving as president of both the Northeast Medical Center in Concord and Presbyterian Hospital in Charlotte.
“Our health care system in this country isn’t as broken as most people think,” he says. “On the contrary, I would argue it works well in repairing people when they show up at hospitals with their problems.”
“The reason that health care costs continue to skyrocket,” says Revels, “is that people neglect their health and then show up in the health care system when their need for services and procedures is most dire—and most costly.
“It is easier and far less expensive to diagnose and treat chronic health problems as early as possible. A person who discovers he has high blood pressure when it is still borderline in the higher range may be able to control his condition using less costly, non-invasive care.
“But most Americans procrastinate. They wait too long to respond to symptoms,” Revels points out. “The vast majority of insurance claims are not used for preventative health care.”
“If you get people to respond earlier, you reduce both the cost of health care and the number of specialized services they need,” says Revels. “Early detection is key.”
Your Health, Your Responsibility
In 2005, Revels founded LivingWell Health Solutions in Charlotte, to help employers reduce their health care costs by engaging employees in proactive disease prevention activities.
“Our program helps companies succeed in controlling health care costs,” says Revels, “and at the same time, makes people healthier—a win-win situation.”
The company has an impressive rate of growth: its business has doubled every year since 2005 to its current client base of 140-plus companies in 15 states, providing health risk management to about 26,000 employees. LivingWell’s client retention rate is also impressive—98 percent.
LivingWell delivers on its promise to significantly reduce the number of insurance claims by offering convenient personal services to support individuals with their health improvement efforts, and by administering a financial reward system consistent with government regulations that enables employers to provide incentives to employees actively participating in wellness programming.
LivingWell’s Health On-Site service consists of clinics staffed by nurse practitioners, offering chronic disease management, health evaluation and coaching, and diagnosing and treating minor medical conditions. Nurse practitioners can also write prescriptions, treat minor medical conditions, perform routine and specific physicals, and analyze lab results. Employees make appointments or stop in the clinic as necessary.
“Employees receive routine health care and can manage their chronic conditions such as high blood pressure, high cholesterol and diabetes,” explains Revels. “We also offer coaching and specialized programs such as smoking cessation and weight management.”
“Our approach is a paradigm shift for employees, telling them: ‘Your Health is Your Issue,’ and you need to take responsibility for it.”
The cost of providing care at a Health On-Site clinic is significantly lower, or about 61 percent of the cost of a visit to a doctor’s office, says Revels.
Companies today have employees that are less healthy than they were 10 or 15 years ago and it is more expensive to take care of them, says Matt McQuide, a broker with Benefit Control Companies in Charlotte who recommends LivingWell’s risk management program to his clients.
“When we started offering on-site clinics, we saw real results,” says McQuide, a 15-year veteran in the field of helping companies better manage their health care costs. “It works. Employees get healthier and claims go down.
“It’s the only thing I’ve ever seen that gets people healthier—and they don’t resent it,” continues McQuide. “It’s convenient, and easy to use. You don’t have to wait six weeks to get an appointment, take off half a day of work, and sit in a waiting room for an hour just to see your doctor for 10 minutes only to get kicked out when your time is up.”
The Health On-Site clinics help individuals understand and work with the individual health risk assessments they receive when they begin in the LivingWell program. Other options are available to companies to participate in a wellness program without offering the on-site care.
LivingWell’s HealthDIRECT program provides for health assessments and the development of annual intervention plans which are presented to program participants. A Health Educator either on-site or by phone coaches and guides individuals in their efforts to remain healthy.
Creating a Personal Relationship
LivingWell follows HIPAA regulations to ensure confidentiality and safeguard the health information of employees who visit its work site clinics. Employees sign medical release forms to allow LivingWell to receive information about their insurance claims. Any results of routine screen or lab tests conducted by LivingWell will be sent to the employee at their home.
“It gives employees a way to talk to their health care practitioners,” explains McQuide, “helping them create a personal relationship they didn’t have before. Sue stops in the clinic to get something for her sinus infection. All of the sudden, she’s talking about her blood pressure and high cholesterol and has an appointment set up to come back in a month to get both checked.”
McQuide has clients in all industry sectors. He works with 14 clinics open from four hours a week for a company with fewer than 100 employees to a full-time clinic with three nurse-practitioners for a company of 6,000.
“In story after story, we hear how much people like the clinics,” explains McQuide. “At first, we weren’t sure if blue-collar workers would embrace the idea, but they did. I’ve been to meetings where truckers tell each other that they need to go to the clinic, and when asked if they liked the clinics, stood up and clapped. I know of a CEO who started the clinic but had no intention of using it. He eventually visited, found out he had cancer and was able to go get treatment for it.”
LivingWell’s Revels says he hasn’t found a client yet that did not experience desirable changes in plan costs and improvement in the health status of plan members.
“Today’s more sedentary lifestyle in which many of us are working long hours in high-stress jobs exposes us to health risk factors,” says Revels. Revels cites his personal background as an example.
A native of Durham, he attended both UNC and Duke. His family medical history includes a father who had a heart attack at age 49 and open-heart surgery at 51. As a hospital president, he was very aware of the studies linking preventative health care with improved health and lower health care costs. Still, he was too busy to regularly visit his doctor and found himself cancelling appointments for physicals because it took too much time.
“Life is so fast-paced. If I’m out of the office for half a day, I have 144 e-mails when I return,” he says. “People don’t want to be away from work today. Companies are downsizing and there are less people to do the work. Employees want to keep up with their work load.”
Now, with a Health On-Site clinic just steps away from his office, Revels takes part in health care screenings. The nurse practitioner reminds him to stop in check his blood pressure and it’s fast, easy and convenient for him to do it.
Attesting to Healthy Results
Karen Ingram coordinates benefits for the city of Salisbury. Her office has been working with LivingWell for more than three years and offers an on-site clinic for 20 hours a week, four hours each weekday.
“The individual Health Report Card given each employee,” says Ingram, “is easy to read and color-coded like a stoplight: red for health risk factors that need to be improved, yellow for health risk factors that need to be watched, and green for health risk factors that are okay.”
The individual is responsible for improving his or her health, says Ingram adding, “The nurse practitioner does not ‘cherry-coat’ the health risks.”
Everyone from the Salisbury mayor and City Council members to policemen, firemen and sanitation fleet workers frequent the clinic, says Ingram, adding that 99 percent of employees are very pleased with the services while a few complain that they don’t want to hear about their problems or be told they need to lose weight.
Salisbury saw a marked improvement in its insurance rate claims after the first year and expanded its program to allow the spouses of employees access to the to the Health On-Site clinic.
Ingram says the city will implement a compliance component to the program in July, requiring employees with red or orange risk factors to visit the clinic either quarterly or every six months, depending on the condition.
While most employees choose to participate in LivingWell’s program, others may be encouraged to do so by financial incentives, or disincentives, offered by their employer.
“Some companies offer participants to pay up to 20 percent less for their health plan membership than those plan members who opt not to proactively address their health issues. The LivingWell Adherence Program is based on people taking reasonable steps to attempt to minimize their health risk. The rewards are not based on arbitrary outcome goals,” says Revels.
LivingWell’s clients range from retailers to professional services from textile mills and lumber plants to mines and universities. Even hospitals and physician groups participate. One option available for smaller companies is to open a cooperative Health On-Site clinic, working together to both pay for its cost and find a location convenient to employees from the participating companies. The first cooperative clinic opened last July and there are now two, one in Kannapolis and the other in Lenoir City, Tenn.
Two state departments are also part of LivingWell’s client base. The North Carolina Departments of Commerce and Treasury are involved in a demonstration project to evaluate the impact of health improvement programs. The UNC Center for Health Promotion and Disease Prevention has been engaged to provide an objective evaluation of health impact over the first two years of the project, says Revels.
According to Revels, health risk management programs like LivingWell are expected to see continued support from the government as the new health care reform bill takes effect because programs that engage people in a meaningful way to manage their health conditions will be eligible to offer higher incentives to individuals.
“Instead of offering employees a discount of up to 20 percent on their health care contributions or premiums, the new legislation would allow employers who offer risk management programs to offer a 30 percent and in some cases, 50 percent discount,” explains Revels.
But Revels says he does not look to the federal government to solve or bring down the high cost of health care. He spoke recently about the success of LivingWell’s solutions as part of a Congressional panel.
“Government-controlled health plans are not a good business solution,” says Revels. “Private employers can step up to the plate and see light at the end of the tunnel. I have proof—LivingWell Health Solutions is changing lives and saving money.”