Dr. Joseph Sanford and Dr. Kevin Sexton, Leaders of the Medical Claims Analytics Teams at Stephens Insurance

Frank Thomas interviews Dr. Joseph Sanford and Dr. Kevin Sexton on employer wellness programs. They explore the data sets that are available between self-funded and fully-insured plans, the changes in healthcare visits since the start of the pandemic, the kinds of nudges that work to help employees to choose healthy behaviors and participate in wellness visits and screenings, and the economic costs associated with the treatment of late-stage illness and early-stage illness, especially with various common cancers. They explore how employers can save money with an effective and iterative wellness program while helping their employees reach optimal health outcomes. Listen to this educational discussion for ideas to improve your wellness program with Stephens.

Key Takeaways:

[:42] Frank Thomas welcomes Dr. Joseph Sanford and Dr. Kevin Sexton of the Stephens Insurance Medical Claims Analytics Teams to the program.

[:56] COVID-19 is still disrupting many businesses. More than half of the U.S. workforce continues to work remotely. Career pressures are at a high in this atmosphere of workplace uncertainty. Employers need to structure more efficient wellness programs with a better understanding of the risk profile of their populations to drive positive outcomes.

[1:32] No wellness data set is complete and all wellness data sets are at a risk for bias. Individual, family, societal, and environmental factors impact health conditions and have to be approximated for a given population.

[1:57] With the pandemic, more people are comfortable with receiving health care online. There is a growing national conversation about value-based care.

[2:20] Wellness plans are designed to be preventative. Employers can encourage behaviors that keep employees in the best health possible. A well-planned program typically includes an annual wellness assessment through a survey, a biometric component with lab tests, wellness visits, and ongoing engagement with individual employees.

[3:28] Age-appropriate screenings for common cancers help employees and employers catch early-stage cancers when they are treatable at a far lesser expense.

[4:36] Encouraging wellness visits can help stabilize variations in care, decrease stop-loss plan costs, and result in more predictable models that help everybody. A new approach to wellness, including time scheduled during the workday for wellness visits, will require a culture shift.

[8:11] A company can help build a culture that focuses on the safety and well-being of its employees. A 2019 report in JAMA shows that employees in a wellness program are more likely to report healthy behaviors like exercise and active weight management or dieting. Wellness programs do not have to be a large expense.

[9:38] Working with a self-funded plan, Stephens is able to access all the claims data and use that data to isolate key drivers of cost. In a fully insured program, Stephens only sees aggregate medical and prescription spending. Stephens considers self-funded plans to be more flexible.

[10:23] Analytics can play a valuable role in providing direction to a self-funded wellness plan. A good wellness program has to be iterative, as a work in progress. Effective online portal interface design can encourage employee participation. Make the things you most want to occur the easiest to do in the plan.

[14:46] Behavioral economics, combining aspects of psychology and economic modeling, helps us to better understand human behavior and why people don’t often make the optimal decision, even when they have all the available information and tools to do so. Nudges can be incorporated into a plan to encourage healthy behaviors.

[16:27] The principles of behavioral economics are to make things easy, attractive, social, and timely. Research by Dr. Katy Milkman on three groups of Google employees with different exercise arrangements showed that flexible incentives work better than incentives that encourage a more rigid behavior or activity.

[18:35] To help employees see the value in a wellness program, institute policies and procedures that foster the best possible employee health outcome, relative to what they could get elsewhere for the same cost. Most people define quality as a perceived outcome divided by the cost they pay.

[20:09] Employers with self-funded programs can use Stephens’ claims data analysis to review more claims, more consistently, in less time. That data allows them to have a quantitative conversation with the employers’ Third-Party Administrators affecting how reimbursements can occur and what will be covered by the plan and how.

[21:25] Employers with self-funded programs are in a better position to demand change than employers relying on insurers, in Dr. Kevin Sexton’s opinion. Insurance companies have their own regulations and priorities for driving down healthcare costs and increasing their margins.

[22:12] Tele-medicine has advanced five to 10 years since the pandemic kicked off in March of 2020. It is used at every level of care. There is an ever-growing list of tools on popular consumer devices that bring diagnostic capabilities into the home. Sharing health data is as easy as sending an email or text message.

[25:02] Dr. Joseph Sanford predicts the future is going to focus on adding robustness to these systems through a hybrid model of a digital-first front door that is supplemented by in-person visits when and as they make sense and then is back-stopped through individual monitoring by personal devices.
[25:25] Dr. Kevin Sexton sees the wellness programs of the future as being highly customized to the individual, providing a mix of incentives and data reporting to help members achieve their personal wellness goals while making sure they’re participating in routine care, like age-appropriate cancer screening.

[25:45] Frank thanks Dr. Joseph Sanford and Dr. Kevin Sexton for their time.

[26:52] For more information on this topic, please contact Stephens Insurance at 1-800-643-9691.

 

Mentioned in This Episode:

Stephens Insurance

Stephens Viewpoints Podcast

JAMA

Richard Thaler
Amos Tversky
Daniel Kahneman

Cass Sunstein

Dr. Katy Milkman

How to Change: The Science of Getting from Where You Are to Where You Want to Be, by Katy Milkman