As a local, county-owned hospital, it would seem a perfect idea that the members of Pomerene Hospital lead Holmes Countys government department into a new wellness program.
With county health claims skyrocketing well past what employees have been paying in, the Holmes County Commissioners are currently exploring ways to cut back on insurance claims.
In a Feb. 4 meeting with insurance agents Mike McDowell and Mike Sommers, as well as Amanda Webb, director of clinical services at Aultman Hospital, and Craig Miller, director of human services at Pomerene Hospital, the commissioners learned about how Pomerene Hospital is reducing its claims, while combating soaring health insurance costs.
McDowell said that they had recently gone over the countys health insurance plan, and said it is always a challenge to come up with a plan that is both cost effective and good for everyone. McDowell said that with the county faces such a huge number of claims, it needs to construct a plan which puts a downward pressure on claims costs.
One such option would be to generate a wellness plan, much like the one which Pomerene Hospital is currently employing.
Sommers said that the key to any kind of wellness plan will be for county personnel to buy into the idea of a wellness plan benefitting them both physically and from a financial standpoint.
Theres no silver bullet in controlling the process of controlling health costs, said Sommers. Weve had several good conversations with department heads, and they are frustrated in delivering that message to their employees. We need to change an entire culture of thinking in order to make this better. Every year (the county) has constantly had an abundance of claims which far exceed what is being paid in.
Miller shared about steps the hospital has taken to manage its claims and health insurance costs. The first was on a wellness plan, while the second was a more controversial method of creating incentives and penalties in how their employees are paying into the health care plan. The first move was to demand that any employees spouse whose employer has a health plan must be taken off of the hospitals, and the spouse must go on their employers plan.
Weve run into cases where people were paying their employees not to be on their plan, said Miller. Any of our employees children can still be on our plan, but if their spouses employer has a plan available, they must use it. Every employer needs to step up and take care of their own.
The second adjustment in their health plan zeroed in on tobacco users. If employees use tobacco products of any kind, they are now paying an additional $20 per paycheck toward health insurance costs. Miller said it is an idea which is much like at-risk drivers paying more for auto insurance.
People should be responsible for their behavior, and if a person is going to enter into a high-risk situation, that is their decision, said Miller.
Every employee will go through an initial nicotine test, and will then undergo one once per year. When questioned about the possibility of secondhand smoke registering on the tests, Webb said, Secondhand smoke would have to be extremely high. It simply isnt going to show up on this particular test.
Miller said that while the hospital could have given a 20 percent surcharge to tobacco users, they were far less than that at $20. He said that spouses will not be tested under the plan at this point.
Miller said the hospital has also taken on another change in its hiring practices. They will no longer hire anyone who uses tobacco products. Miller said that they will screen possible new employees much in the same manner that they do for marijuana.
In addition to the health insurance practices, the hospital has also undergone an extensive wellness program which offers incentives to those who choose to pursue a healthier lifestyle. Pomerene has joined Aultman to create a plan in which wellness coaches from Aultman will do testing and screening, create appropriate, individualized wellness plans and reward those who meet all of the necessary requirements.
Every employee who decides to try to meet the wellness challenges will meet with their wellness coach quarterly. The coach will document all of the meetings, and employees must turn in any documentation of required meetings and appointments.
All of the information is run through Aultcare, and Miller said that while many employees were concerned that the hospital would be looking over their shoulders constantly or would be privy to private information, Aultman has a scorecard which keeps track of all of the wellness information, and Pomerene has no inkling of the activity, other than to know the progress each employee is making. In addition to the wellness program through Aultman, Webb said that there will be incentives offered for employees who make a commitment to cease smoking.
As long as the employee is making an honest effort to follow through on their plan, they deserve their reward, said Miller. The reward is $100 for the first year, as Pomerene sees how the plan goes, but Miller said the biggest benefit will be doing things which are good for them anyway. The hope is that the employees will invest their time into the wellness plan, thus becoming healthier, leading to fewer claims being submitted.
We wanted to create a plan which presented very tangible results, said Miller, who added that while they would like to see 80 percent of Pomerenes employees on the wellness program plan, it will take time.
McDowell told the commissioners that the county plan would not have to be identical to Pomerenes. You can build yours any way you feel comfortable, and for what feels right for you, but what you want to do is to put the onus on the employees for pursuing healthier lifestyles, which will in turn reduce claims.
