Calibre’s view on the future of the provision of Health & Wellness services to Organisations and their Employees
Part 2 – Self-Funding – The Calibre Service Proposition
Employer Self-funded or Self-insured healthcare programs are often preferred over fully insured programs by many employers because self-funding offers portability, optimal flexibility and greater customisation of stop-loss strategy, healthcare plan design and plan administration, reduce premium tax and commissions, and provide the greatest level of transparency in knowing the true costs of healthcare plan administration. In addition, cost savings resulting from favourable claims experience remaining in plan reserves, unlike fully insured programs where premiums are an unrecoverable cost. On-site Clinics primarily benefit self-funded employers, as it provides a cost-effective way to deliver primary care for employees and sometimes their dependents. To benefit, an employer needs to have a critical mass of employees near a common location. This strategy is geared for savings without cost-shifting. It also helps employees to establish a relationship with the primary health care provider. There is a cost to the employer to launch an on-site or near-site clinic and an employer should budget for the cost of the clinic set up, and staffing costs, with either point of care/screening & laboratory costs as well as prescriptions medication. Third-Party Administrator (TPA)/external specialists are available to help employers strategise on the initial build-out of the clinic.
The overall Employee and Organisational Wellness Strategy (see table below) commences with what might seem to be the smallest component of the strategy, however, an efficient TPA requires to be available for employees, members and beneficiaries at all times. This can best be achieved through a 24-hour toll-free call-in line including a Member App facilitating outbound conversations and data collection, all linked to the elements discussed below. The 24-hour toll-free Health & Wellness communication line & App is the entry point to organisational wellness, which thereafter becomes an expansive service offering unique to the client and the client needs. In so far as it encompasses the overall wellness proposition and provides the TPAa unique insight into the possible impact the workplace might have on the wellbeing of an employee, it also provides an insight into the risk that an employee might have on the organisation. The 24-hour line & App cannot exist on its own and it drives the following functions and needs;
- Administration (TPA) ensures the smooth and seamless running of the full programme and further ensures that contract deliverables and the SLA’s are met. Administration gleans much of its success or shortcomings from the 24-hour toll line & App.
- Administration seeks to align all stakeholders. Collaboration is an essential function of the administrator so that there is no duplication of services, and where there may be an overlap, identify this and ensure that it does not frustrate the intended programme outcomes. Such collaboration may include medical aids and their designated service providers, pension and provident funds, occupational health providers, shop stewards, peer educators or any other identified stakeholder to ensure that the consolidated communication strategies related to the programme are attained.
- Administration helps steer the client Consultation process, which aims to align the various building blocks in a total wellness offering, tailored to complement one another. Consulting seeks to consolidate information and data received, from appropriate sources, for analysis and interpretation for purposes of reporting to the organisation.
- Statistical and other data analysis derived from the 24-hour call centre & App is the backbone of Programme design/Programme refinement and guides the formulation of new or enhanced client offerings in line with corporate objectives and policies as well the actual employee needs.
- Reporting is the essential requirement of the Administrator in which the programme intentions, deliverables and outcomes can be represented to the organisation and should at least provide the organisation with some indication of a return-on-investment (ROI).
There has been a tremendous amount of international research showing the benefits to companies where organisational budgets have included health spend, allocated to preventative and primary care. “Prevention is better than cure.” This is not only true but also the best way to ensure productivity, preventthe cost of absenteeism and the overall cost of healthcare spend in any organisation. There is a significant ROI for any organisation when they are serious about the health of their employees. The most significant element to preventive care are the following;
- Personal Health Risk Assessments (PHRA) – These are screening assessments, performed annually during organised Wellness Days. The standard screening tests are;
- HIV screening
- Glucose screening
- Cholesterol screening
- Blood Pressure screening
- Body Mass Index (BMI) screening
- Tuberculosis (TB) screening using a questionnaire
- Other possible endemic screening
These screening tests are ideal to obtain a snapshot of the health of the individual and the organisation. These screening test results are not diagnostic but rather a trigger result for the individual to see a medical professional for further follow-up and investigation. This is also an opportunity to counsel an individual on Lifestyle Changes and Risk Prevention Strategies in relation to the possibility of developing diseases. The results of such Wellness Day screenings further allows the organisation to consider the long-term effects of the health of the employees. It further informs the executives on the Formulation of Strategy to mitigate the negative consequences identified during the screening exercise.
Preventative and Primary care can be provided via an On-site Clinic or Mobile Facility that is owned by the client, and run by the Administrator ensuring the most effective, and confidential healthcare delivery system. An On-site Preventative and Primary Clinic also ensures that employees do not have to queue at State Healthcare Facilities to obtain treatment and which results in a full day away from work. The On-site Clinic is the critical element to support all healthcare efforts, ensuring employees are Fit-to-Work and the workplace and the environment is safe to work in to the management of acute illness to ensure that it does not develop into chronic conditions. The On-site Clinic further supports a healthy and productive workforce preventing unnecessary time off work and generally has the following elements;
- Acute care for the everyday health needs that require a nurse or doctor intervention to prevent the onset of a Chronic Illness or the development of a serious condition requiring hospitalisation.
- Chronic care for those employees that have a Chronic or Lifestyle Disease that enquires regular medication and monitoring to ensure that they do not become ill and need hospitalisation or time off work due to illness.
- Employee Assistance Programme (EAP) can be delivered via a Telephonic Consultation or Face-to-Face, On-site or Off-site, depending on the organisation and the employee needs. EAP deals with all the psychosocial issues those employees, their dependants experience, and that impact on their ability to perform effectively at work. Intervening in these instances can have an enormous impact on the productivity and profitability of the organisation.
- Environmental Hygiene Assessments – The activities and measurements the occupational hygienist generally considers during the assessment are as follows;
- Airborne pollutants
- Thermal Stress
- Indoor Air Quality
- Vehicle Gaseous Emissions
- Hazardous Chemical Substances, including Lead and Asbestos Monitoring
- Vibration Monitoring
- Endemic services –Endemic services are considered for organisations that operate in environments that have diseases particular to that environment i.e. West Africa where Typhoid and Yellow fever are common and impact heavily on absenteeism, disability and death in the workplace. Of course, these diseases are preventable through immunisation and as such, the endemic services focuses on such programmes. It also important for organisations to ensure that their Executives when Travelling are appropriately vaccinated and provided with the appropriate “Health Travel Kit” suite to the itinerary. Often additional support is required for employees in remote sites where particular endemic diseases exist, like Malaria, infested sites where impregnated malaria nets can help prevent infection.
- Family planning – This has become a very important aspect of primary care as more and more women of childbearing age are employed in the workplace. Many woman experience unplanned pregnancies because of poor family planning. These unplanned events affect heavily on the employee and the employers alike and therefore when primary care provides such a service the cost impact on both parties is significantly reduce.
- Occupational Medicals, “Fit-for-Work”– Annually or routine medical examination of employees to determining their health status in relation to their work is critical to the prevention of occupational diseases, disability, incapacity and accidental injury. All the information gleaned from the 24-hour call centre, the risk analysis and the prevention interventions go to support the medical practitioner to assess the employee’s Fit-for-Work Occupational Health further provides health mitigation strategies in the form of recommendations on Personal Protection Equipment (PPE) and the referral of an employee to primary care for medical intervention and management where necessary.
- Seasonal Interventions – This can include a Vaccination Programme to deal with flu. In certain areas disease like Cholera and/or Malaria become more prevalent during particular seasons and then the primary care environment can play an important role in education and prevention including vaccination, early detection and treatment.