Q: How can the new workers' compensation program help employers save money?
A: 'In Ohio, 96.3 percent of injured workers recover and return to work; that's an all-time high,' says William W. Pfeiffer, president and CEO of CareWorks. 'With the advent of managed care, we're really speeding up [the process of] helping the injured worker get back to work. Getting workers back more quickly cuts costs to the employer, not just in indemnity costs, but in the costs of temporary workers, training new workers and loss of efficiency.'
Q: What factors should a company consider when choosing a health plan, especially in a tight labor market?
A: 'One of the biggest mistakes a company can make, especially in a tight labor market, is to trim back health benefits to cut costs. By doing so, companies risk losing highly trained quality employees,' says Robert N. Trombly, chief administrative officer of Medical Mutual of Ohio. 'The cost of hiring and training new employees may exceed the expense of offering a quality health-care package. A number of alternatives empower employees, including flexible-benefit designs and different cost-sharing options.'
Q: What should small-business owners consider when choosing a health-care plan?
A: 'Some of the key factors are: What is the quality of the network; and what are the affiliations with the doctors and the hospitals?' says Thomas A. Sullivan, interim president and CEO of QualChoice Health Plan. 'You really have to be aware, as an employer, of what is available and what you are really looking for in terms of accessibility [and] benefits. What is their reputation in the marketplace; are they able to pay claims? And you should be able to call any organization and get answers to your questions.'
Q: Why are preferred-provider organizations (PPOs) becoming more popular?
A: 'The pendulum is swinging back to PPOs, and a large part of the shift is in employers desiring to give their employees more choice in their health-care options,' says Joan Mason, executive vice president and COO of Ohio Health Choice. 'Employers basically want to offer their employees health-care options, so organizations that help them customize plans and manage savings will benefit those employers the most.'
Q: What roles should employers and individuals play in holding down health-care costs?
A: 'The role of the employers, since they are ultimately paying the bill, is to hold the employee somehow responsible for their decisions,' says John Jesser, vice president of health-care management at Anthem Blue Cross/Blue Shield of Northern Ohio. 'The employers' role is to structure their benefits in a way that rewards healthy lifestyle choices. The employee's role is to make healthy lifestyle choices. Evidence shows a healthy diet and exercise reduces heart disease, yet we lead the industrialized world in heart disease. There are things people can do that they are consciously not doing, which add to health-care costs.'
Q: How can a company encourage its employees to keep costs down through the use of generic drugs?
A: 'Your employee- benefit plan should include financial incentives to encourage employees to purchase generic drugs in place of brand-name drugs,' says Joe San Filippo, COO of Nationwide Health Plans. 'Our three-tier copayment plan aligns the purchase decision with the cost of the drug. The lowest copayment always applies to generic drugs.'
Q: What role does rehabilitation play in returning an injured employee to work?
A: 'It is important for returning an injured employee to work as quickly and as safely as possible,' says Carolyn Zimmerman, certified rehabilitation nurse and case manager with ProHealth CompCare. 'Find out the injured employee's physical limitations from the physician. The employer, working with the MCO, can consider a job with modified duties for a specific period. The MCO monitors the progress of the employee and periodically re-evaluates his physical limitations.'
Q: When should a company consider conducting a health-care audit?
A: 'An audit is normally for self-funded accounts. A company that has not had an audit in three to four years should be a candidate,' says Dennis Mormile, certified financial planner with Employer's Indemnity Company of Ohio. 'It not only finds dollars, it finds strategies to tighten up the administrative end. They'll usually get about a 6-to-1 return on their investment in the audit.'
Q: What are the advantages to using a full-service, mobile medical provider?
A: 'The convenience is the number-one advantage, eliminating the lost wages and downtime and having one provider for all services,' explains Tracey Skorman, sales manager for Zenza Mobile Medical Service. 'For the employers, there is the convenience of knowing where their employees are, not paying lost wages or having lost time.'
Q: How has the health-care job market changed?
A: 'It's tough to find good people in an industry that has been volatile; it's become a little bit tougher because industries like managed care and health care are not willing to accept just a normal candidate. They want the Michael Jordans, the top 5 percent,' says Dale Chorba Jr., manager of Action Management Services. 'Years ago, they would take someone in banking or retail and figured they would teach them. Today, they want someone with technical skills.'