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Benefits Column

Simple Solutions that Work

HR leaders can look at the elegant simplicity of the iPhone as a model for seeking out integrated health benefits that offer robust programs as well as cost-effective solutions. Disability claims, in particular, can offer complex coordination problems.

Monday, May 10, 2010
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It's no secret that I love my iPhone. This allegiance is not driven by a desire to be seen as a trendsetter. My iPhone is part of my technology DNA because it simplifies my life.

On the other hand, the longer I'm around employer-based benefits, the more I realize how much they complicate everyone's lives.

That's why I was intrigued by a conversation with Tracie Foster, director of product and business development for Anthem Life, about a new benefits-plan design they rolled out on May 1. Tracie is the lead for "Productivity Solutions," a program that integrates an employer's health, short-term disability and disease-management plans.

It turns out that Tracie and her employer may share something in common with Steve Jobs, the visionary behind my beloved iPhone.

Jobs describes problem-solving as a three-step process in Steven Levy's book, The Perfect Thing: How the iPod Shuffles Commerce, Culture and Coolness:

1. "When you start looking at a problem and it seems really simple with all these simple solutions, ... your solutions are way too oversimplified, and they don't work."

2. "Then you get into the problem, and you see it's really complicated. And you come up with all these convoluted solutions. ... that's where most people stop, and the solutions tend to work for a while."

3. But the really great person will keep on going and find, sort of, the key, underlying principle of the problem. And come up with a beautiful elegant solution that works."

While I think we're beyond oversimplified benefits solutions, it feels as though we haven't moved beyond health strategies that use duct tape and baling wire.

So what's Productivity Solutions' beautiful elegant solution for employers' health and disability plans? A truly integrated design with a single employee entry point into one or several health-related programs -- pre-certification, medical-case management, behavioral-health case management, transplant team, disease management, wellness programs, health coaching, short-term disability -- from anywhere in the Anthem Life/WellPoint system.

While there are complicated algorithms at work behind the scenes, the experience to the employee is simple -- just like my iPhone. And as long as the employer has at least 50 covered employees in both the medical and STD plans, they're automatically part of Productivity Solutions.

Several things struck me about this benefits product from a cost-effectiveness perspective.

The program is robust. Case managers can notify the disability-case managers of possible short-term disability claims. Disability-claim examiners may use an employee absence as a leverage point to get the worker to a health coach.

The program takes in the big picture. Even if the disability-claim manager denies the STD claim, they can still refer the employee to a health coach.

The program follows the worker from start to finish. The health coach, who acts as the member's advocate, calls the employee no later than 30 days after they return to work to see how they're doing.

Other major health carriers that also offer disability plans, such as CIGNA and Aetna, have their own take on combining their health-related programs.

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But what if you don't want to consider consolidating your health, disability and disease-management benefits under one roof? As HR leaders, you can require your vendors to coordinate their programs

Dr. Ronald Leopold is MetLife's national medical director and vice president for U.S. business. Ron has been advocating for the integration of medical and disability benefits for nearly a decade.

"We recognize that eight to 10 percent of the working population goes out of work on a STD claim every year," Ron says. "These employees represent 50 percent of the employer's healthcare dollars." 

If you consider that your employees are vulnerable when they leave work due to an accident or illness, you will realize the "untapped potential disability gives you to impact your employees' health," Ron says.

Your disability carrier or third-party administrator can coordinate with your disease and health management vendors at the point of STD claim notification to get these employees the assistance they need when they are most open to it.

In addition, carriers such as MetLife will also send claim-level data to your third-party data aggregator so you can match this information with other health data to fully understand the impact from program coordination. Not all vendors are willing to export claimant-identified data, so if this analysis is important to you, be certain to ask about their capabilities.

As HR executives, whether you integrate or coordinate your benefits, craft an iPhone-like experience for you and your employees by creating a beautiful, elegant, simple solution that works.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett.

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