Across the Generations - Physical Wellness

With technology advances and initiatives by both public and private data warehouses, we have better visibility into healthcare and prescription drug claims than we’ve ever had to assist in identifying areas we can target to decrease benefit costs to companies, while supporting the overall health of their employees better. With most data collection for the purpose of data driven healthcare starting in the early to mid 2010’s, the U.S. has enough information to begin analyzing trends and targeting healthcare behavior. It’s important to review your own company’s claims data, consider company demographics, the industry in which your company falls, and the type of work in which your employees are most often engaging to identify benefits that would best serve your population. For example, a company who has employees that are on their feet all day will have different needs than those who are mostly stationary at a desk. In some instances, it may make sense to break up your claims data by groups of individuals, such as administrative versus manufacturing (if the population is large enough to protect employee privacy). If the dollars available for a company to spend on benefits are limited, targeting benefits to address the highest costing claims or impacting the most number of participants will allow for the greatest return on investment with potential of adding more benefits as cost savings are realized with better claims management.

It is common practice to request access to industry data from a benefits consultant or broker to identify what other companies comparable to your own are offering and to identify benefit trends, however, you may also find it advantageous to ask your insurance company what they are targeting for their fully-insured population. Insurance companies spend a significant amount of time and money in analyzing their own claims data and identifying programs to assist in addressing large areas of spend to effectively manage costs and can provide insight into areas not visible to you.

One segment of employee information that is useful to review, and supports our focus for the month of July, is generation/age. Below we have provided common challenges facing individuals classified in each of the five generations currently included in the U.S. workforce. We’ve also provided the table shared last week identifying common birth years attributed to each generation, characteristics and preferred communication style. It’s important to consider not just the benefits offered, but that education and information provided about the benefits offered are provided in a clear manner in a format that will engage employees the best. It’s clear the preferred communication style varies greatly between the generations, but the services you’re communicating will most likely target a subgroup of your population who has a clear communication preference identifying the best way to effectively raise awareness to the intended audience.

It’s worth noting the concept of moving from a reactive to a proactive mindset in regards to holistic well-being really began to take root in the 1980’s, with a major push towards preventive medicine in 2010 when the Affordable Care Act (ACA) was passed inclusive of the requirement for all health plans to cover preventive visits and suggested screenings in full, with no payment from the participant. Prior to the introduction of preventive healthcare, individuals were typically using health systems as “sick care”. Patients really only saw their doctor when they were ill…or if their parents made them go in lieu of going to school. The greater adherence to preventive visits, the better chance for early treatment with better outcomes which will greatly reduce healthcare costs.

Traditionalists

It should not be surprising that the oldest population would generally have the greatest healthcare costs. Traditionalists are far more likely to struggle with a chronic condition with the most prevalent being hypertension, high blood pressure, and arthritis which includes treatment that often coincides with the highest prescription costs. Adding access to a robust chronic disease management program will help your affected population manage their condition better, improving the effectiveness of their treatment leading to better outcomes and saving the plan money. These conditions have historically had the highest number of medications with a patented brand name drug available for treatment. Implementing prescription drug programs with your carrier will help manage these costs. Programs to consider are mandatory generic prescription which will require the generic be utilized where available and where the generic is just as successful in treating the condition, step therapy which would require certain medications that have proven to be effective be tried first, and adding a requirement the participant have maintenance drugs filled with a 90-day supply which reduces the cost to fill the prescription, and reduces the frequency the participant needs to go to the pharmacy. Bonus! A program restricting the pharmacy a participant utilizes to one or two chains, or to use mail order for refills, is another strategy to consider. We did not include this as a suggestion in the table below because it can cause greater disruption than benefit, especially for companies who have employees in more rural locations. Exceptions can be built into the program to allow for alternative pharmacies to be in-network if a chain is not accessible in the event this is a strategy that may offer significant cost savings. Both chronic condition management and prescription drug programs typically offer mailed communication options, as well as phone outreach which may be useful to this population in managing expectations and reducing frustration.

Traditionalists are all of Medicare eligibility age and many have access to Veterans Affairs (VA) benefits. How these benefits coordinate with your health plan can be very confusing to the employee as it can vary greatly. Ensuring your education is clear and easily accessible in regards to the order of payment that will apply between the insurance companies in various scenarios, and if there is any action the participant needs to take, will assist in preventing claim payment surprises, potential confusion, and undue stress. We do not recommend any internal representative counseling employees or their dependents on Medicare or VA benefits, as the rules are complicated and can change frequently. As a sneak peek to what will be addressed when we highlight financial wellness in a couple of weeks, offering access to a knowledgeable advisor may be beneficial, especially as this population transitions to retirement.

Baby Boomers

The challenges Baby Boomers are facing are, not surprisingly, very similar to the Traditionalists generation. However, Baby Boomers are more likely to have multimorbidity (multiple chronic conditions) which can cause complications in successful treatment. Treatment for one condition may interact negatively with the treatment for another, or cause complications in identifying a successful treatment. Again, this population would benefit from chronic disease management programs which may help to monitor treatment across several doctors and provide assistance in identifying potential treatment interactions. Prescription drugs programs can also provide relief for high prescription costs for medications, especially for cancer prescriptions, if the medication is being billed as a prescription and not a medical claim. Cancer treatment is consistently the leading driver of high cost claims. Prescription drug programs will also adjust formularies as new medications are introduced such as biosimilars which can greatly reduce the cost of treatment. Yay for advancements in science!

Baby Boomers may also appreciate access to Supplemental Medical Benefits such as Critical Illness or Hospital Indemnity to assist in potential costs resulting from an eligible condition/hospital stay, especially if they enrolled in a high deductible health plan (HDHP). Supplemental Medical Benefits would pay money directly to the participant for eligible expenses to assist in covering out-of-pocket healthcare expenses on which they had not planned, or towards living expenses if their treatment results in a loss of income. This is another example of how important holistic well-being is and how much the segments overlap as we will discuss this more during our financial wellness review.

This population will also benefit greatly from targeted education on coordination of benefits with both Medicare and VA benefits but should include the importance of understanding Medicare Part D (prescription coverage) creditable coverage requirements, which would result in a lifetime penalty if not handled correctly.

Generation X

Generation X fully understands and agrees preventive care is important, but studies show roughly half of the population have not had an annual physical in the past five years. For comparison 72% of Baby Boomers have had an annual physical in the past five years. Generation X has been referred to as the “sandwich” generation because they are caring both for their own children and their aging parents. The most cited reasons for not getting the suggested preventive screenings is lack of time and simply forgetting to schedule them. They are so busy taking care of everyone else, they forget about themselves. The good news is this population is open to utilizing telehealth medicine if it is convenient. Adding targeted communications from your insurance company to remind them of missed screenings will assist in increasing adherence. Leverage email communication where possible and provide links to telehealth options, or online scheduling capability for ease of use. In addition, increase education regarding preventive care coverage under the plan to discourage avoidance due to concern of out-of-pocket costs for a doctor’s visit. Finally, adding a healthcare rewards program that offers incentives for completing various activities, including completing preventive visits will provide added motivation.

Data shows that Generation X has an increased prevalence of musculoskeletal disease which can cause persistent pain, and mobility/dexterity limitations. Adding musculoskeletal health benefits to your coverage will help with identifying successful treatment and reducing cost of care. Providing ergonomic assessments, trainings, and equipment to your population will help reduce the effects of the disease to individuals already struggling, and prevent new cases across your full employee population. This is a great way to show your entire workforce their well-being is important to you, and increase their comfort and safety at work.

Generation X is at the prime age for symptoms of menopause to begin. Up to a third of women report symptoms of menopause being so severe they affect their ability to be their best at work, and may lead to missing work entirely. Those affected would greatly benefit from access to menopausal/reproductive health services which provide assistance in managing menopause symptoms and related health challenges to support their overall well-being.

With age goes vision. Vision exams have become an essential part of preventive care, not only for the health of the eye, but also for detecting illnesses such as diabetes, heart disease, high blood pressure, high cholesterol, rheumatoid arthritis, some STDs, thyroid disease, and vitamin A deficiency. Ensuring your vision insurance is adequate is an essential part of supporting employee well-being and encouraging utilization. Current trends are for the plan to cover the full cost of the annual eye exam, or require a very low copay ($10-$35). The average stipend provided toward contacts or glasses every 12 months is $150. Tele-optometry services are available with some providers and may benefit this population.

Millennials

Millennials are also likely to fall short when it comes to preventive care adherence for themselves, but the individuals in their family are also likely missing recommended preventive care. Reminders from providers would assist this population in obtaining the recommended care, with plan coverage education addressing any concerns over out-of-pocket costs. A healthcare rewards program may incentivize them to complete needed tasks, and if possible, extending incentives to their covered partners may encourage better adherence within the family, as well.

Millennials are also experiencing early onset of chronic conditions with the most prevalent being Type 2 Diabetes and Hypertension which often occur together in individuals who are considered obese. Many chronic disease management programs include resources to better encourage healthier lifestyles which can greatly improve the long term health of individuals diagnosed with these conditions earlier in life.

As more individuals choose to wait to have children until later in life, fertility challenges have become a concern to many Millennials. Fertility health benefits have become highly valued for many Millennials and can greatly increase attracting and retaining top talent in this generation. Consider bundling fertility health benefits with menopausal health benefits beneficial to Generation X with the same reproductive health company for potentially better pricing, allowing for a more inclusive benefit across the generations. Many of the same carriers also provide adoption and surrogacy options that are highly valued by the LGBTQ+ community to assist in promoting more fully inclusive family planning options.

Studies show that Millennials not only devalue the importance of dental care, they actively avoid it. Unfortunately, this generation does have significantly worse teeth than prior generations, often attributed to poor eating habits and more non-traditional lifestyles, such as remote work, which increases prevalence of poor dental hygiene and could be a contributing factor for some of the other challenges Millennials are facing. Poor oral health can lead to other illnesses such as cardiovascular disease, diabetes, erectile dysfunction, and infertility, for example. The top reasons cited by Millennials as to why they avoid the dentist is that they don’t have time to schedule the appointments, and they are concerned about the cost of going. Offering comprehensive dental coverage can alleviate some of their financial concerns, but may not be enough for this population as studies show 88% of individuals in the U.S. have access to dental insurance. Consider adding concierge services to assist them in scheduling appointments and estimating out-of-pocket costs to alleviate their stress. A healthcare concierge service can assist participants in identifying providers, increase price transparency, understanding benefit coverage, and even scheduling appointments. This service can also be used for medical and vision services and is often highly valued by employees with very low investment by the company. You can also opt to include preventive dental visits as an incentivized component of your healthcare rewards program.

Generation Z

Generation Z is just learning about benefits and some may still be on their parents’ coverage. Help them learn benefit literacy early by providing engaging, on demand, short education videos defining basic terminology and key elements of your plan design, as well as how to use their coverage and special enrollment requirements for enrolling in employer sponsored coverage. Though they may not be enrolled in your company benefits, increased understanding of healthcare will promote healthier living and assist in maintaining costs as the age out of eligibility under their parents’ insurance.

Though Gen Z has had the benefit of a lifetime of preventive medicine, they expect seamless experiences and instant gratification, unfortunately neither of which define the U.S. health system currently. Due to this, they are far more likely to utilize urgent and emergency care which is far more costly to them, and the plan. Increased education regarding the importance of establishing primary care and directing them to resources to find in-network providers to utilize will assist in decreasing the use of higher costing facilities with less effective treatment. Provide short, concise instructions as to how to access virtual visits on your medical carrier’s website, if available. An added strategy that assists in preventing frequent ER visits is to apply an increased cost share for ER utilization for services that are not considered an emergency. For example, a non-emergent ER visit would result in a flat dollar penalty ($200 perhaps) or a higher coinsurance percentage owed by the participant.

Gen Z has far greater interest in using medical data to obtain a clearer picture of their personal health than the generations prior to them. Building robust wellness programs that provide ongoing tracking, access to health assessments, and biometric screenings will be valued more by this population but make sure the program remains engaging and does not become stale. Including wellness challenges and ways to connect with others within the organization will prevent losing their interest.

Need help ensuring your benefits support the physical wellness of your employees? Centurion At Work is at your service! Contact us to learn how we can help maximize the impact of your benefit programs to promote holistic well-being across the generations.