By Sandra Gurvis
In 2006, The Ohio State University offered its employees new health insurance plans developed by its own Human Resources and Medical Center experts. Three years later, hospitalizations and emergency visits are down, more than 75 percent of participants are very satisfied with their health care and the University has saved approximately $12 million in health plan costs through contract improvements, disease management, medication purchasing changes and health improvement programs. Further analysis is required, but needless to say, the University is pleased with the trends.
In these times when escalating healthcare costs, battles with insurance companies, and physician and patient frustrations dominate the healthcare headlines, there is a thread of hope: personalized, preventive medicine. The Ohio State University has taken this strand and woven it into a tapestry of employee programs, tools and incentives known as Your Plan for Health (YP4H). Components include Personalized Health Assessments (PHAs) that qualify faculty and staff for discounts on their premiums; financial “rewards” for good health habits; health and lifestyle improvement programs ranging from nutrition to tobacco cessation; and individual “health coaching” to promote wellness and help coordinate care for people with chronic health conditions.
Part of the beauty of YP4H is that it was developed internally, tapping many experts within the University, particularly from the Medical Center. “From the beginning, there has been strong collaboration,” observes Larry Lewellen, Ohio State’s vice president for Human Resources. “Such is not always the case with large organizations, especially if they are geographically disbursed.”
In fact, interwoven with five medical insurance plan options, YP4H blankets the entire University, including regional campuses and extension offices. “We use local physicians and hospitals and link them with Ohio State,” remarks Pat Temple Gabbe, MD, MPH, senior medical adviser for OSU Health Plans. “Our goal is to integrate the health-delivery system with the physician and healthcare provider, avoiding duplication in billing, treatment and other aspects.”
YP4H has also partnered with physicians, providers and medical assistance powerhouses such as CareAllies, a health adviser and care coordination company, and WebMD, which powers YourPlanForHealth.com with database tools that personalize user experiences.
Even though coverage and benefits greatly increased with YP4H, prices and costs did not. Premiums for 2007 and 2008 went up only an average of $20 per person, member admissions to hospitals dropped 3.4 percent and Emergency Department visits dropped 4.4 percent. By identifying people who are susceptible to chronic conditions and helping them manage their care, changes in contracts, medication purchasing, and other refinements, the University has saved nearly $12 million.
A Quilt of Benefits
“For years, we discussed how to create something larger than our current health plan offerings that would represent a best practice for Ohio State,” continues Lewellen. “With a culture of caring for faculty and staff, the University has a history of successful wellness programs. But we wanted to create a robust resource that would figure out the information each individual needs based on his or her health experience and history, while at the same time increasing their involvement and awareness.”
And there was the pattern of rising premiums. “The question was how to improve the quality of wellness and care while avoiding a huge increase in long-term costs,” adds Scott Streator, CEO and executive director of OSU Managed Health Care Systems (MHCS). So, with the support and blessing of University leadership, the OSU Human Resources/OSU Medical Center team carefully pieced together what eventually became Your Plan for Health. “From [Ohio State] President Gordon Gee on down, University leaders walked the walk and talked the talk, focusing not only on their own personal health but that of faculty and staff, and their family members.”
The key to success, however, lay in convincing all parties involved that their contribution was vital to the finished product. “There needed to be a shift in focus,” points out Wiley W. “Chip” Souba, MD, ScD, dean of the College of Medicine and vice president and executive dean of Health Sciences. “Historically, the relationship had been between doctor and patient.” Now, a whole team of caregivers was to be involved, from healthcare coaches to nurses for care coordination and a 24-hour Nurse Line to WebMD. A centralized online Personal Health Record allows the faculty or staff member to enter health information, including immunizations, allergies, lab results, medications and more.
To carry out the design, “The patient needs to assume more accountability for his or her health,” continues Souba. In terms of YP4H, this includes taking advantage of free biometric screenings available at several campus locations, which provide faculty and staff with their health numbers: blood pressure, resting pulse, triglyceride values, waist circumference, glucose and cholesterol levels, weight and height. Participants also needed to become accountable for diet, exercise and other healthy habits, making health care a two-way street.
A Comforter for All Seasons
Actually, it was more like a busy intersection than a two-way street, considering the number of parties involved. And therein lies a potential snag. “During the first year or so, there were a lot of privacy concerns,” admits Lewellen. “People were asking, ‘What are you going to do with all this information?’”
“Data integrity was – and remains – a big priority,” emphasizes Streator. Along with strict adherence to the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), the system was set up so that responses to the PHA and health-status information remain strictly confidential and have no impact on premiums, benefits eligibility or employment decisions. However, those selecting the option of releasing information to the MHCS health plan were eligible for additional benefits, such as coaching and other health-management programs.
As a result, “participation continues to grow,” observes Gretchen Feldmann, communications manager with Ohio State’s Office of Human Resources, Benefits. PHA participation jumped some 88 percent between 2006 and 2007; over the last three years, the University has realized a 51-percent PHA participation rate among benefits-eligible faculty and staff. No doubt people have been enticed by up to $180 in premium reductions for employees and the Faculty and Staff Incentive Program. The latter is a point system that allows people to earn an additional $125 by engaging in activities that promote prevention, education, wellness and health management, such as exercising or even visiting the dentist.
Even non-PHA participants now have lower caps on prescription drug costs, enhanced dental benefits and family member discounts, in addition to subsidies for tobacco cessation, weight management, nutrition counseling and fitness center memberships. They also receive benefits for alternative therapies – medical massage therapy, acupuncture and chiropractic care.
“One of the critical aspects of personalized health care is that everybody receives the advantages of participation and prevention, and that it extends to the community at large,” remarks Steven G. Gabbe, MD, senior vice president for Health Sciences and chief executive officer of Ohio State’s Medical Center.
Sewing a Bigger Blanket
A recent survey conducted on behalf of Ohio State’s Office of Human Resources and Managed Health Care Systems indicated that 75.5 percent of faculty and staff are “very satisfied” with their health care. Not surprisingly, the figure exceeds the national average. And, word got out on preventive care as well. Almost 8,000 faculty and staff took advantage of the free biometric screenings at dozens of campus locations in 2008.
But the OSUHR/OSUMC weavers of YP4H are hardly content to rest on their laurels. “Our goal is to take ownership in the transformation of health care and its delivery,” observes Streator. “It’s not enough to wait until someone gets sick and then treat them.” Through the PHA and other data, “many conditions can be managed, if not completely avoided, at an early stage.”
“YP4H is just a beginning,” adds Temple Gabbe. “We have a long way to go toward an efficient delivery system that makes the best use of the healthcare dollar – it’s still very fragmented and redundant.”
Like Steven Gabbe, the Medical Center’s research leader and Center for Personalized Health Care Director Clay Marsh, MD, sees YP4H as the first step in integrated, universal health care that begins not only at the genetic level but is available to everyone, through all stages of life. “We need to switch from disease-based to preventive – part of a P4 model that includes predictive, personalized and participatory, and with a fifth P – precise.”
top from left: Clay Marsh, MD
Pat Temple Gabbe, MD, MPH
bottom from left: Wiley W. "Chip" Souba, MD, ScD
Steven G. Gabbe, MD
• Even with greatly increased coverage, health plan
member admissions to hospitals dropped 3.4 percent and ED visits dropped 4.4 percent. These and other results saved nearly $12 million.
• YP4H members can obtain premium discounts, financial “rewards” for good health habits, health and lifestyle improvement programs, and individual “health coaching.”
• Medical Center leaders see YP4H as the first step in integrated, universal health care available to all, through every stage of life: preventive, rather than disease-based.