Back when employers paid the entire healthcare bill, workers cared more about having hassle-free access to care than the cost of insurance. So how do they feel now that more of their own money is stake, due to rising coinsurance and copays?

Pretty much the same, according to an HRI survey.

Choice is still king

The study looked at firms offering two types of plans: one with higher out-of-pocket costs but easier access to primary and specialty care, the other with lower costs but HMO-like restrictions on specialty care.

The majority of employees said they were willing to tolerate out-of-pocket costs if it meant maintaining choice. What’s more it didn’t matter whether the employee was aware of how much coverage cost either their employers or themselves.

Implication: Organizations with consumer-driven healthcare plans may need to tweak the educational messages to employees. Rather than focusing just on making people aware of the cost of care, employers should also stress the need to make smart healthcare choices.

In other words, people care mostly about choice (even when they know it means paying more themselves), but still need help with the responsibility.

Real-life practice

How can you put this idea to work in your organization? By stressing:

• The cost-sharing arrangements at your organization enables employees to make healthcare-provider choices for themselves and their families.
• The more that employees research the care available to them, the smarter the choices they make, and
• It’s helpful to offer tools (e.g., a Web site, a nurse call center) to help folks make good choices – but it’s up to each participant to take advantage of these resources.

According to a recent report, these four conditions are the most likely to cause catastrophic claims for self-insured companies:

1. Extreme premature births (24 to 25 weeks’ gestation) can cost $700,000 to $900,000 in hospital inpatient charges and followup outpatient treatments for mother and child. 
2. Liver or kidney transplants average about $760,000 in total claims.
3. Non-transplant kidney disease treatments averages $200,000 to $400,000 in claims.
4. Hemophilia-related claims average about $300,000.

There’s only so far your company can go to determine what percentage of employees are at risk for these conditions. But if you are self-insured or considering that route, you can work extra hard to raise employee awareness and encourage employees and their dependents to undergo health-risk assessments on their own.

A recent study suggests many employees are even willing to pay much – or all – of the cost themselves.  Roughly 35% of firms with wellness programs focus on providing workers with convenient access to weight loss resources.

A poll of 1,352 employees by the Strategies to Overcome and Prevent Obesity Alliance found that many people would gladly chip in for the cost of the program if they believed it would help them lose weight. What employees want:

• confidential support and counseling
• access to a professional nutritionist or personal trainer, and
• onsite exercise programs.

Until recently, only big companies were able offer such programs as part of their wellness benefits. But the fastest growth of these programs in the last two years has been in smaller firms (sometimes with as few as 50 full-time employees).

The majority of firms split the cost with employees. Typically, workers pay up to about 25% of the cost. But some plans are fully employee paid.

The average expected employer cost for a newly diagnosed cancer patient’s treatment is $83,084.

What’s more, typical wellness programs (which often focus solely on lifestyle-related health problems) have little effect on preventing cancer. Lastly, cancer is also the No. 1 cause of employee absences of 30 or more days.

Some good news

Employers nationwide have put their heads together and issued a series of four concrete action steps any firm can use to fight cancer among employees and their dependents. The employer coalition, called the CEO Roundtable on Cancer, recommends:

• Employee health-risk assessments. This is the most important first step of getting any cancer-prevention program off the ground. The assessments should look both at family history and lifestyle issues such as smoking.
• Cancer screenings. Best practice is to pay the cost for your at-risk employees to get screened for everything from skin to colorectal cancer. If even a single case is diagnosed early, it can prove to be a big money – and grief – saver in a very short period.
• Employee cancer education. Companies need to let employees know cancer prevention is a major goal for everyone at the company. Employee education has a cumulative effect, so plug your cancer-prevention resources early and often, and
• Selective use of health coaches. If you can’t afford a wellness program that gives everyone access to a health coach, consider a coach for people with three or more risk factors on
  a health-risk assessment.

Whatever you’d pay for these services would be far cheaper than a single preventable cancer case at your organization, finds the coalition.

Consider accreditation program

In conjunction with the American Cancer Society, the CEO Rountable coalition created a “Gold Standard” accreditation for firms that establish and enforce these and other key prevention policies.

Other key steps: banning smoking on your premises and having smoking cessation, diet and nutrition programs. Long-term, accredited firms could enjoy premium discounts as health insurers begin to recognize the certification.

There’s a good chance your company is carrying people who shouldn’t even be on your health plan.

It’s estimated that two-thirds of employers spend an extra 5% to 15% by carrying ineligible people on their health plan rolls.

The problem usually springs up when your insurance company continues to charge you for enrollees who are no longer eligible for coverage but were never removed from the list of enrollees.

The issue often goes undetected until you initiate the steps needed to find and fix it. Insurance companies have no incentive to do anything about it. It’s not costing them money, after all. It’s costing you.

The usual suspects

There are four main groups of people who often manage to fly under the radar and remain covered under your plan even when they’re ineligible:

• ex-employees
• current employees who’ve changed from full- to part-time status
• divorced employees’ ex-spouses, and
• older dependent children.

Each category has its own set of challenges to fix, but that can be done with relatively little pain.

Track ex-worker coverage

Without knowing it, your company may still be paying for doctor’s visits made by ex-employees.

This doesn’t mean former employees who accept COBRA, paying 102% of the premium each month to keep their coverage and offset your administrative costs.

Rather, the concern here is to spot freeloaders, whose insurance cards were never canceled, while your firm continues to foot the bill. This problem happens more often than you may think.

Some firms generously offer to carry certain ex-employees for a certain period of time and then forget to cancel their coverage. But more often, it’s a clerical error by the insurer that goes undetected.

Be certain there’s someone at your company who tracks when people’s coverage period ends: both on the active rolls and on COBRA.

Ask Payroll about part-timers

Depending on the eligibility rules in the plan documents of your health policy, an employee who scales back on his or her hours may become ineligible for coverage under your health plan.

If that’s the case, ask Payroll to run periodic reports on the enrollment status of the folks whose hours have recently dropped. Remember: COBRA applies. But you needn’t pay for part-timers’ ongoing coverage.

Employees slow to report divorce

It’s an unpleasant fact of modern life: half of marriages end in divorce. Unfortunately, there’s often a spill-over effect on an employer’s health plan after a divorce. Employees often fail to notify their employer about an impending divorce.

As a result, after the divorce, the firm continues to pay for coverage for the ex-spouse. There are two tactics that can help minimize this problem.

1. The “empathetic” approach: Pledge complete confidentiality.
2. The “hardball” tactic: Add a spousal surcharge to employees’ monthly contributions, which greatly increases the odds of prompt reporting of a divorce.

Are you obligated to offer COBRA if a divorce is reported to you well after the fact? If you learn of the qualifying event within 60 days after the divorce date, you must send a COBRA notice. Beyond that, it’s not your firm’s responsibility to offer COBRA if the employee doesn’t report it.

A recent study looking at soldiers returning to work found alarming – and rising – rates of mental illnesses such as post-traumatic stress disorder (PTSD) and severe depression. A reported one in five soldiers returing from the war in the Middle East are diagnosed with PTSD or depression.

The study also looks at how employee assistance programs can help ease the transition back into civilian work.  The average two-year treatment cost per case to an employer is about $10,000. But the potential cost of ignoring the problem is much higher.

Click here to access the  free report.

That’s especially true for managing the health of employees’ adolescent children. Most of the attention goes to pre-natal and early childhood care. But a host of serious medical issues typically emerge during teenage years.

Physical issues

It’s every bit as important for employees’ adolescent dependents to undergo complete health assessments as it is for employees’ themselves. This is especially true for weight management issues.

There has been an epidemic rise in overweight and obese adolescents, which can contribute to (or worsen) a variety of physical and/or behavioral health problems.

Remember: These issues can create large-scale direct costs (treatments for the teenager) and indirect costs (absenteeism and/or presenteeism by the parent(s) who work for you). Other crucial factors:

• immunizations (shots or vaccines) to reduce the risk of getting diseases such as hepatitis, meningitis, tetanus and mumps
• preventive health counseling and age-appropriate health information (e.g., drug and alcohol abuse, sexually transmitted diseases)
• vision and hearing tests, and
• blood-pressure screening (especially if there’s a family history of high blood pressure).

Psychological issues

Regular physician visits provide an opportunity to discuss emotional changes and other challenges that most adolescents experience. In some cases, it’s also a front-line means of referring teenagers-in-need to behavioral counseling.

Remember: Proactive care greatly reduces the risk of a host of chronic and debilitating conditions. It can even be a life-safer in extreme cases.

The survey was conducted by the Mercer consulting firm. Here’s a compilation of the responses (the numbers add up to more than 100% because some companies are trying more than one approach):

• 59% said they intend to keep down rising health care costs in 2009 by raising workers’ deductibles, copays or out-of-pocket spending limits.
• 47% are encouraging enrollment in plans with lower premiums and higher deductibles.
• 19% will start offering a consumer-directed health plan — a high-deductible plan with employee-controlled spending accounts. They encourage employees to save account money by shopping for the best health bargains; the employees can keep the savings for future needs. That’s up from last year’s figure of 12% who said they were very likely to adopt a consumer-directed plan.

More from the study:

• On average, health care costs will go up by an estimated 5.7% next year for workers and their employers. That’s the same as this year’s 5.7%  and slightly less than the 6.1% jump in 2007.
• During that same period, wage increases have averaged slightly under 4%.
• In the last five years, the average health-plan deductible for an individual grew from $250 to $400. For a family, it rose from $1,000 to $1,500.