Frank Diamond

When Tufts Health Plan opened its Be Well Center for its own employees in February, it did so as a self-insured company, the kind that tends to rely more on clinics than those that aren’t self-insured. Tufts wasn’t doing a pilot test of a product to be sold. It has no plan to offer these clinics to employer sponsors or insured companies, says Lydia Greene, vice president for human resources and diversity.

Wellness culture

In this case, Tufts is just one of many companies focusing more on wellness, as was noted in last year’s study of 588 companies by the National Business Group on Health and Towers Watson, which says that 23 percent offer wellness services and another 12 percent plan to begin offering them this year.

Lydia Greene

Lydia Greene

The Be Well Center, which is managed by Take Care Health Systems, a subsidiary of Walgreens, is available to 1,700 Tufts employees on the company’s Watertown, Mass., campus. Be Well complements the insurer’s Working Well Center, a fitness facility that offers classes in nutrition, exercise, yoga, acupuncture, and massage. The Working Well Center, also managed by Take Care, offers 35 classes a week and costs employees $28 a month. The Be Well Center is staffed by a nurse practitioner, a medical assistant, and a wellness coach, and there’s a local PCP who oversees the operation.

Improving productivity and overall workforce satisfaction are goals. The Tufts wellness program began about seven years ago as part of a broad company culture change. “For each of the last three years the annual increase in health benefit costs has been under 3 percent,” says Greene. Yet she concedes that “determining ROI can be challenging.”

The Center for Studying Health System Change has addressed workplace clinics, saying, “Employers need to be realistic about return on investment, and that measurement poses challenges.” The study, “Workplace Clinics: A Sign of Growing Employer Interest in Wellness,” says that while some experts argue that clinics can achieve a positive ROI in the first year, most don’t expect to break even for at least two years, possibly longer. It doesn’t help that there are no industry standards for measurement. “Two types of ROI are typically estimated: ‘hard ROI,’ which measures savings in direct medical costs only, and ‘soft ROI,’ which also includes productivity gains from such factors as reduced absenteeism,” says the study.

Greene says, “What we do know is wellness programs can improve employee morale, and that’s always a welcome ROI.”

For instance, Tufts aims for that most daunting of wellness goals: long-term, sustainable weight loss. That’s where the Be Well and Working Well centers work hand in hand. “We have a full-time wellness coach in the Be Well Center,” says Greene. “She helps identify and overcome whatever obstacles to wellness might be present in a person’s life. She can refer you to our on-site nutritionist or she can give you a free pass to the gym for a couple of months. Close to 50 percent of the individuals who choose coaching over a three- to six-month period are focused on weight loss.”

Endless battle

For years the gym had about 125 members. In the last four years, that’s grown to more than 500, nearly a third of the campus population.

“I would have been pretty skeptical about this four or five years ago,” says Greene. “But my experience here has made a believer out of me. When you change the culture and make it comfortable for an overweight person to be in a gym or participate in a cycling class, you make it accessible and acceptable as a workplace practice.”


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Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
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The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.