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The HealthMine Blog

Small Portion Of Consumers Make Up Big Portion of Healthcare Costs

July 27, 2016
HealthMine Team

Just 1.2 percent of all health plan members account for nearly a third (31%) of all healthcare spending for large employers. This data comes from a new study by the American Health Policy Institute.
Over half (53%) of that disproportionately distributed spending is tied to treatment for chronic conditions. Conditions that were the most costly included cancer and heart disease.
 Left unchecked, healthcare costs for plan sponsors will only grow, according to predictions from the study, because of several key factors. Medicaid costs are expected to surpass $1 trillion per year in 2025. Also, the advancing age of the U.S. workforce means that, in the coming years, the worker-to-retiree ratio is expected to sink below three-to-one.
Additionally, by 2025, 53 percent of private sector employees who are the primary breadwinners for their families will have to spend 9.5 percent or more of their family’s annual income on healthcare. Health care bills that demand such a significant portion of income are considered “unaffordable” by the Affordable Care Act (ACA).
Speaking of the ACA, the excise tax or Cadillac Tax will start affecting average value plans, not just the expensive, “Cadillac” plans for which the tax was intended, by 2031.
To summarize, the key factors of rising Medicaid costs, an aging workforce, rising average health plan costs, and the Cadillac Tax will snowball to bring health care spending to unmanageable levels in the next 10-15 years.
But, we have the potential to turn this trend around.
The analysis concludes that both public and private sector efforts should focus on chronic disease, increased wellness program participation, and predictive biometric screening to engage plan members and turn them into “active plan participants.” These measures empower health plans to identify the highest risk members who carry the bulk of the costs. They also mobilize individuals to know their health status and engage in actions that will help them avoid or closely manage costly conditions down the line.
For the complete study from the American Health Policy Institute, click here.
[Photo Credit: Tax Credits on Flickr via Creative Commons 2.0]

Cancer May Be Preventable, But Screenings Are Needed

July 21, 2016
HealthMine Team

Exciting new research revealed that cancer may not be unavoidable, as was previously thought.

A combination of healthy eating, exercise, quitting smoking, and a number of other factors could significantly reduce cancer risk. In other words, the spectre of cancer, previously an arbitrary and devastating diagnosis thought to be based on genetic lottery, could be preventable.

In addition to behavioral change, there needs to be a move to increase screenings so people are aware of the risk factors that could lead to them developing cancer. A 2015 HealthMine survey found that 37% of people don't know what cancer screenings they need to get and how often.

This is where wellness programs come in.

Despite the clear connection between certain activities, such as smoking, and the development of cancer, 74% of wellness programs currently do not screen for cancer. This data comes from a July 2016 HealthMine analysis of 750 wellness program participants.

Previous data indicated that even with demonstrable benefits to completing health actions like cancer and biometric screenings, people are unlikely to do any of them without an incentive. Yet 80% of wellness program members say they do not get incentives to complete cancer screenings.

Cancer is projected to overtake heart disease as the number one cause of death in the U.S. within the next 15 years. With the possibility of averting cancer now on the table, wellness programs need to be making cancer screenings available and incentivizing participation.

For the complete article in the New York Times, click here.

[Photo Credit: rachieray34 on Flickr via Creative Commons 2.0]

Diabetes Patients Spend 4X More on Healthcare Each Year

July 12, 2016
HealthMine Team

According to a recent report from the Health Care Cost Institute (HCCI), health care spending per capita for people with diabetes was a whopping $16,021 per year, compared to $4,396 for people without diabetes. Diabetes patients, in other words, pay nearly four times as much for healthcare as those not suffering from the disease.
The HCCI also found that the rate of health care spending growth for diabetic patients was nearly twice what it was for all other insured people. The report surveyed insured Americans between 2012 and 2014, both those with diabetes and those without.
Given that about half of Americans have diabetes or pre-diabetes, how are we going to turn this alarming trend around? Part of the answer may lie in wellness programs, which can help in two specific ways. Wellness programs can prevent and/or early detect diabetes in those who are at risk, and it can help those who are already diagnosed better manage their diabetes. How can wellness programs help? By applying clinical data to close gaps in care.
For example, approximately one-third of Americans have diabetes and do not even know it. Surprisingly, two-thirds of this undiagnosed population has seen a doctor two or more times in the past year. Wellness programs that automatically intake and analyze an individual’s health data from multiple sources can be an early detection system when providers are not. Early detection can lead to better treatment, prevention of co-morbidities and reduced utilization.
For those already diagnosed with diabetes, 73% say they have difficulty coping with their illness and 66 percent feel their diabetes is not completely under control (according to a 2015 HealthMine survey). Nearly a third (30%) of those with pre-diabetes do not know that their condition is reversible.
A well-designed wellness program could provide pre-diabetic members with personalized recommendations to avoid developing the full-blown disease. It could also support those who are already diagnosed with necessary health actions and dynamic incentives to manage and control their disease. It could send these reminders digitally, to members' smartphones, engaging them anytime, anywhere.
As the numbers indicate, increasing the focus on diabetes prevention and management would not only improve health outcomes, but also result in real savings for the healthcare consumer—and for plan sponsors who help foot the bills.
For the full report from the Health Care Cost Institute, click here.
[Photo Credit: Alan Levine on Flickr via Creative Commons 2.0]

A Dose of Technology for Population Health

July 5, 2016
HealthMine Team

Providers are increasingly applying technology to improve the health of large populations--and plan sponsors can take a chapter from their playbook.
A recent article in the Wall Street Journal expands on this notion. Tools like telemedicine technology, smartphones, and mobile health applications allow individuals to have greater access to their health data. They connect patients and caregivers in new ways, making healthcare more convenient and affordable. Other tools empower people to monitor their health status, meet diet and fitness goals, and even remotely manage chronic conditions such as heart disease and asthma.
While barriers remain, such as the healthcare industry’s conservative culture and varying state legislation that limits the reach of telemedicine across state borders, the potential for this technology to have real positive impact on individuals’ health outcomes is real.
The potential is just as great for health plan sponsors as it is for providers. Technology-driven wellness programs cannot only help people reach lifestyle goals, but also catch chronic diseases before they become full-blown. They can help identify those who need extra effort to avoid emergency visits and hospitalizations.
If wellness programs entered the digital era, applying innovative technology tools and perhaps even combining them with predictive analytics, they could serve as early warning systems. Digital wellness programs could empower individuals to take charge of their own healthcare, to make smarter lifestyle choices, and to reduce the likelihood of developing a chronic illness later in life.
For the complete article in the Wall Street Journal, click here.
[Photo Credit: Logan Ingalls on Flickr via Creative Commons 2.0]

Wellness Programs Lack Digital and Real Time Components Needed To Engage Users

June 29, 2016
HealthMine Team

A recent article in Forbes pinpointed ten reasons a wellness program may not be meeting goals, both in terms of health outcomes and cost savings targets.
1. You use scare tactics.
2. You incentivize poorly.
3. You don’t offer biometric screenings.
4. You only offer biometric screenings.
5. You don’t consult experts.
6. You communicate poorly, if at all.
7. You chose the wrong provider.
8. You skip the employee feedback.
9. You force participation.
10. You’re stressing out.
No wellness program is perfect, but engaging and sustaining all members in personalized health and disease management activities is the goal, and this list helps identify common gaps. The truth is, wellness is not well. Despite $8 billion invested annually by U.S. health plan sponsors in wellness programs that promise health improvements for participants, results have been disappointing. Participation rates in wellness programs are low and plan sponsors struggle to engage members. HealthMine consumer research found that 70% of plan members who are enrolled in wellness programs don’t feel the programs meet their needs.
The biggest hurdle for wellness programs today is that most are stuck in an analog era. America is a mobile, always-on, data-at-your-fingertips society. So why are today’s wellness programs stuck in the past, using outdated approaches to data collection and analysis, reporting, and delivery technology in attempts to engage plan members in their health?
If members are to be motivated to take responsibility for their health, to take action when it matters most, they must know the current status of their health, and especially changes in the status of their health, right now—not six weeks from now.
A wellness program will sustainably engage its population when it can provide every member with answers to three key questions anytime and anywhere in near-real time:
1.    What is my current health status?
2.    What can I do to improve my health right now?
3.    What’s in it for me?
The ability to digitally pull in and analyze clinical and behavioral health data from many sources is essential. A wellness program that does this can be an early warning system for health risks and chronic conditions.
As is evident from the Forbes list, there are many “don’ts” when it comes to wellness program design, but this is one clear “do”: deliver recommendations, incentives and updates to members’ smartphones in near-real time, when it matters most.
For the complete article in Forbes, click here.
[Photo Credit: KatieThebeau on Flickr via Creative Commons 2.0]

Wellness Program Participation Makes Sense (And Cents)

June 20, 2016

Is it worth it? That seems to be the lingering question in plan sponsors’ minds when they decide between various wellness program offerings. There’s strong evidence that these programs aid employee attraction and retention. But do wellness programs deliver measurable return on investment (ROI)?
The answer to that question, according to recent data from Priority Health, is yes.
According to their admittedly small sample (9 midsized, self-insured employers), employees enrolled in a wellness-based plan cost 12 percent less than those who had a standard plan over a four-year period. That translated to $60 saved per employee per month--or $1.2 million saved over four years.
A three-year study conducted by HealthMine in conjunction with UnitedHealth Group of 120,000 members also found measurable savings from participation in a wellness program. Over a three-year period, the member population reduced hospital admissions by 10 to 20 percent and reduced hospital readmissions by 50 percent.
Another hospital group in New Jersey saved more than $5 million over five years with a member population of just 8,000.
As the saying goes, an ounce of prevention is worth a pound of cure. It pays off, in other words, for plan sponsors to sign up their members in wellness programs.
[Photo Credit: Tax Credits on Flickr via Creative Commons 2.0]

Only 6% Are Doing Everything They Can To Ward Off Chronic Disease

June 13, 2016
HealthMine Team

The headline from this recent article on is pretty bleak: “Almost no one in the U.S. does everything right, healthwise.”
If you read past the clickbait, however, there is a more optimistic message to be found about the important role of wellness programs in helping individuals get healthy and stay that way.
The Centers for Disease Control and Prevention (CDC) identified five key actions people could take to reduce the likelihood of developing a chronic condition, like heart disease or cancer.
The key actions themselves should all be familiar: not smoking, exercising regularly, drinking in moderation (or not at all), maintaining a healthy weight, and getting seven or more hours of sleep each night. These actions have been the subject of PSAs, First Lady Obama’s “Get Moving” campaign, and other public awareness efforts. Yet despite their ubiquitousness, just 6% of people do all five.
Wellness programs generally focus on two categories of health: 1) lifestyle, which is focused on prevention and cultivating healthy habits, and 2) chronic disease management, which focuses on managing conditions once they have already developed.
Needless to say, preventing a chronic disease is easier and less expensive than managing one, and the five key actions described by the CDC should be fundamental ingredients in wellness programs. Programs that target all five health-related behaviors will have more success as they implement a coordinated approach, rather than a narrow focus on one aspect of health.
Plan sponsors looking to optimize health outcomes: take inventory of your wellness programs and be sure you are helping to drive engagement in these five essential health behaviors. And don’t stop there; it’s important that you measure the outcomes in your population to know whether you are moving the needle.
For the complete article from, click here.
[Photo Credit: maxiub on Flickr via Creative Commons 2.0]

Shopping for Healthcare with a Blindfold On

June 9, 2016
HealthMine Team

The cost of one medical procedure can vary widely depending on where you look. This is according to a recent article in HealthDay News that focuses on the cost discrepancies of x-rays and computerized tomography (CT) scans.
The analysis found that the cost of these medical services may be higher at hospitals than at independent imaging centers. The average x-ray cost at a hospital was $140, compared to $76 at an imaging center. An average CT scan was $1,146 at a hospital, compared to $585 at an imaging center. Hospitals may also be slower to provide pricing information to the consumer, the story reported. And the issue of price transparency is not unique to radiology.
Most states do not have laws that guarantee consumers access to health cost information, according to a joint analysis performed by the Health Care Incentives Improvement Institute and the Catalyst for Payment Reform.
Today, buying healthcare services is equivalent to grocery shopping with a blindfold on and being held responsible for a bill that comes long after you’ve consumed the goods.
The lack of price transparency contributes to lack of consumer engagement in health. Three out of four consumers do not price shop for medical services, according to a 2015 HealthMine survey. And yet one out of five insured Americans have avoided visiting a doctor for a general health concern within the past 12 months because of the cost.
“[Price transparency improves] cost awareness among both physicians and patient consumers," said Dr. Licurse, one of the co-authors of the study.
If employer wellness programs could evolve beyond simple lifestyle management to a set of tools that facilitate healthcare consumerism, individuals could be more informed, engaged and empowered to manage both their health and the financial costs.
For the complete article in HealthDay News, click here.
[Photo Credit: MilitaryHealth on Flickr via Creative Commons 2.0]

EEOC Ruling Clarifies Wellness Program Incentives--But What Next?

June 2, 2016
HealthMine Team

In the wake of the recent Equal Employment Opportunity Commission (EEOC) ruling on wellness program incentives, “wellness” has been the word on everyone’s lips.
The much-anticipated final ruling clarified how two federal laws, the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA), affect group wellness programs. Specifically, wellness programs can provide incentives up to 30 percent of the single employee premium for participating members and also for their spouses.
Looking back at the pre-ruling landscape, concerns around privacy, efficacy, and cost-savings have stifled wellness programs over the years. The EEOC ruling did a lot to address these concerns and despite any lingering questions, one thing is clear. Wellness programs are here to stay.
But now that plan sponsors have some clear lines in the sand around how much they can incent members in wellness, how do they determine the most effective ways to do so? The next question plan sponsors must answer is: how do I structure wellness incentives in a way that grows member engagement?
As it stands, there is a serious issue of lack of engagement in wellness. According to an October 2015 HealthMine survey, 70 percent of wellness program participants say current wellness program offerings fall short and 55 percent of wellness program participants don’t earn their full incentives.
With the rules of the game in place, wellness programs can now begin to incorporate evidence-based incentives. This means applying incentives strategies and recommendations that are backed by rigorous behavioral science research and the best practices of high-performing wellness programs.
But how can plan sponsors ensure that they get the most bang for their buck?
Knowing their members and customizing both health recommendations and offers is a good place to start. Incentive options can be personalized for each individual member based on their health profile, behaviors and self-reported preferences. Personalized incentives are more meaningful and motivating.  They can help create deeper engagement--and great ROI.
For the complete article in Politico, click here.
[Photo Credit: Tax Credits on Flickr via Creative Commons 2.0]

​Why Consumers Need a Healthcare Compass

May 24, 2016
HealthMine Team

It’s a brave new world of healthcare, with many different roads and new drivers behind the wheel: the healthcare consumers themselves. No longer passive recipients of care or passengers steered by the assurance that their insurance plan will “cover” their needs, consumers are being handed more responsibility and agency in decision-making around their own health.
But it’s a long way to go between simply giving people the ability to make these choices and expecting them to make thoughtful and informed ones.
As individuals are expected to shoulder a much higher portion of their healthcare costs, that heightened responsibility is creating anxiety. A survey from GoBanking Rates, a personal finance site, revealed that every age group, except those under the age of 24 and over the age of 65, selected healthcare costs as their biggest source of financial stress. Driving for the first time can be scary--and costly.
Consumers are ill-prepared to manage their health through consumer directed health plans (CDHPs), where they now bear a much larger burden of the bill. Most don’t know their basic health metrics like blood pressure and cholesterol. The majority never price shop for medical services. Driving your own healthcare requires you to be both proactive and preventive.  But consumers don't know where to start, and they don't have a compass.
That is where there is a pressing need for guidance and education in healthcare consumerism. And there is room for the employer to help support those efforts.
Bryce Williams, CEO of Healthmine, recently shared with EBN three ways employers can educate employees:
Arm them with knowledge to understand their health status and risk. Giving them access to personal clinical data — like their biometric measurements and an analysis of their historical medical and pharmacy usage — will help shed light on their health needs, including necessary preventive care. 

Be transparent about health care costs. Providing a way for members to look up doctors and procedures and compare quality and costs will facilitate follow-through. It will also help members save money. 

Personalize health care programs to make them more meaningful and engaging. This means helping each member set personal health goals and providing tailored recommendations to get them there. Employers could up the ante on incentives and rewards for health by matching personal preferences with cash, gift cards, lowered premiums and more. 

For more explanation from Williams on how to deploy these strategies, read the complete article in Employee Benefit News here.
For the complete article on consumer directed health plans, click here.
[Photo Credit: Lovelorn Poets on Flickr via Creative Commons 2.0]