Taxpayers share burden of health care costs
One of the biggest drivers of municipal budgets each year is the rapid rise in annual health care costs. In an attempt to slow this rising expense, Manchester officials are asking employees to pay more for their insurance, take better care of themselves and go to less expensive doctors.
Last fiscal year, Manchester paid a total of $44 million in health insurance claims. Of that, $19.5 million was on the city side, a 16 percent increase from the previous year, according to information from Anthem Blue Cross Blue Shield New Hampshire. The city paid out about $6,000 per member last year, which includes employees and their families. This amount is 14 percent higher than the norm for Anthem customers in New Hampshire.
The city of Nashua, by comparison, paid out $25 million for employee health insurance. Nashua's health care costs rose about 6 percent last year. A projected 11 percent increase was avoided by implementing health care changes that included a 10 percent increase to premium-cost sharing and changes in plan design that introduced deductibles and slightly increased co-pays.
According to Anthem, Manchester offers “a very robust” plan and pays a higher percentage of their employees' health insurance benefits than any other city or company in Anthem's New Hampshire book of business.
These statistics are why the city pushed so hard to get concessions on health care costs from unions this year. These concessions have freed up millions in vital funds during the city's first budget under the tax cap, but officials are still looking for ways to manage rising costs in the long term. Officials are also looking to programs that encourage employees to live healthier and shop for better deals for common medical procedures.
An Anthem study of city employee insurance claims last fiscal year showed that 25 percent of emergency room visits could have been treated in another setting and 52 percent of claims were related to lifestyle issues, including overeating or smoking.
In Nashua, programs were started to address some of the issues that contribute to increased health care costs. An annual wellness fair provides city employees with a variety of information on diet and healthy living. Cholesterol testing, blood pressure reading and other screenings are available at the event.
Lunch and Learn events educate people in an informal setting. Walking programs and a program that contributes to the cost of joining weight watchers are two more services offered in Nashua to address specific concerns.
Manchester hosts annual health initiatives to get employees to exercise more, and for the past two years it has offered employees cash incentives through the COMPASS Smart Shopper if they opt to go to a less expensive provider for more than 40 common procedures whose costs can vary by thousands of dollars.
City employees who are having a blood test, colonoscopy or gall bladder removal, for example, can call the COMPASS hot line and get the different prices at medical offices in the Manchester area. If an employee selects one of the three most cost-effective providers, that employee receives a check for a fraction of the city's savings. The incentive check can be between $15 and $500, based on how much money the choice saved.
Although the COMPASS program has the potential to save the city thousands of dollars, employee use is low. According to Anthem, about 500 employees have used the program so far, and many of those have done so only recently. Unions and staff have begun to encourage their coworkers to participate, which has helped, as has inviting spouses of employees in to seminars about COMPASS, said Lisa Guertin, Anthem president.
“We really do feel it's possible to grow that number. ... We had the biggest month ever last month,” said Guertin. “What's great for us is some of those people are becoming the champions of this and the ambassadors of this. They tell employees, 'It was a two-minute phone call and I got a check for $250.'”
Elliot Hospital CFO Rick Elwell has seen little effect on business from programs such as COMPASS and questions whether price alone is enough to get patients engaged.
“If I blew out my knee ... I'm going to be more concerned about getting surgery with someone whom my primary care physician is very comfortable,” said Elwell. “At the end of the day, I don't want to walk around with a limp.”
There are options,Elwell said. At Elliot Hospital, patients can be given the choice of having a procedure done at a lower cost to them or at a higher “tier” at another provider with a higher co-pay, Elwell said.
These programs are similar to efforts being made at other companies and institutions in the state, such as the University of New Hampshire. UNH insured 6,300 employees, retirees and their families, spending about $63 million per year. The state school has launched a website, Healthy UNH, to provide information to both staff and students about living better and playing a more active role in their health. UNH also has a program called Tandem Health Advantage, which offers incentives for people to use less expensive providers.
Josephine Porter is deputy director at the New Hampshire Institute for Health Policy and Practice at UNH. Before programs such as COMPASS and Tandem can become effective, she said, employees have to learn more about their health care options and how the system works.
“There is a lack of understanding from a consumer perspective about what they have a voice in,” said Porter. If a doctor tells a patient to get blood work done, there often isn't a conversation about the choice in labs available, she said. “I still don't think people understand they can make the decision and have a role in it.”
“That's why I think the phrase having people get 'skin in the game' is not accurate,” said Ned Helms, director and clinical professor at the UNH health policy institute. “You have to give people tools so they can connect.''
Amy Schwartz, director of the Health Care Cost Containment, said since the Tandem launch in January, the program has attracted about 100 people per month. To bring more onboard, Schwartz sends educational material out via emails and webinar, as well as in person. These face-to-face sessions where people can ask questions directly have been the most effective way to get people involved, she said.
To give employees those tools, UNH holds frequent seminars about not only how to use the Tandem program but also what questions to ask at the doctor's office, said Porter.
Manchester Alderman Garth Corriveau has also proposed beefing up employee health education. He suggested hiring a health care overseer to educate employees about cost savings plans, wellness initiatives and other health issues, such as reducing needless visits to the emergency room and lifestyle-related illnesses. While aldermen look into hiring a health care liaison, Anthem and COMPASS pledged to include funds for such a person through the city's health administration costs.
Persuading patients to get involved is vital to tackling the problem of cost, said Guertin, but it is also one of the biggest hurdles.
“Getting people to engage as consumers in health care as they do in every other aspect of their lives, it has not existed,” said Guertin. “Trying to get people to stop and think about it with everything going on in their lives is a challenge.”
Union Leader Correspondent Julie Hanson contributed to this story.
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