Health

Health Care Resource Guide • 2015 – 2016 9 Building the Foundation for People of All Abilities Seven Hills Foundation offers a continuum of integrated supports that build confidence, community, friendships, and independence. For over 60 years, we have helped transform the lives of thousands of individuals who are now using their abilities to overcome challenges and embrace opportunities. Community living is setting the standard for all of our programs, which include: • Developmental Disabilities Supports • NeuroCare/Brain Injury Supports • Behavioral Health Supports • Medically Intensive Supports • Residential Options • CareerSource Workforce Readiness Seven Hills staff provides care with compassion and encouragement for everyone to SEE the possibilities, BELIEVE in their abilities, and ACHIEVE their dreams. 81 Hope Avenue, Worcester, MA 01603 • 508.755.2340 • www.sevenhills.org Quality primary care, behavioral health, dental care, and vision care for the entire family. Family Health Center at Webster Square 645 Park Avenue Worcester, MA 01603 (508) 792-7580 www.FHCW.org/WebsterSquare Family Health Center - Southbridge 29 and 32 Orchard Street Southbridge, MA 01550 (774) 318-1445 www.FHCW.org/Southbridge Family Health Center of Worcester 26 Queen Street Worcester, MA 01610 (508) 860-7700 www.FHCW.org DCU's Fontaine and Fallon's Prze- siek suggested that they engage a health benefits broker to look at their entire programs. He said there has been a considerable consolidation in insurance brokers due to financial pressures on the health care industry. Carey concurred. "It's very important to have a good broker. If you meet just one time a year at renewal time, it's not going to work." On the employee outreach side, gi cards, walking programs and events win people over. "You don't have to have 5,000 employees to do these," Przesiek said. Fontaine observed the popularity of DCU's Free Food Friday program. Selling common sense When former WBJ editor and panel moderator Rick Saia asked the panel how they maximized partici- pation and reduced pushback, Carey responded that Polar had made the health insurance education meetings mandatory. One particular point: If employees had to go on COBRA if they lost their employer coverage, the premiums would cost them $1,500 a month. Employees don't see the fees that the employer pays, he added. Ad- ditionally, he said, there is pressure on employers to provide properly-coded information for new hires within a three-month time window; any infor- mation that doesn't fit the 17-unit cod- ing template gets rejected. All the more reason, Fontaine said, to hire a broker, and to maintain a partnership with them throughout the year. She also said DCU had moved back to dispersing employee benefit statements – until participants see the hard numbers, they don't recognize the value of their insurance coverage, she said. "Our employees don't like deduct- ibles either," Fallon's Przesiek said; the company is encouraging the adoption of high-deductible Health Savings Ac- counts. Sheehy, of Reliant, cited programs intended to promote smoking cessa- tion and minimize workplace injuries. A key difference in health care brought about by the ACA has been the merged market. As of Jan. 1 2016, the merged market – individuals and small-business – expands the business side of the equation from employers of 1-50 to 1-99, which puts employ- ers of 51-99 into the community-rated category. "Some may look into self-in- surance to get the benefit of their own company experience [to comply with the Affordable Care Act]" he said. Przesiek concurred. While Massa- chusetts has been implementing the ACA model since 2006, he said he did expect that small-business groups with 51 to 99 employees would look for health care coverage alternatives with the impact of the 2016 deadline. The dilemma of small companies Saia asked what role the employer should play in educating employees to use the lowest cost provider. Carey responded that the choices could be an ER copay of $250 or a visit to an urgent care clinic for $15 to $20 out of pocket, for situations not considered to be potentially life-threatening. "We found a lot of staff going to the ER for strep throat," Fontaine said. Instead, she recommended the use of minute clinics. "Educating members, this is where we need employer help," Przesiek said. "We send a lot of materials that don't get read. Anything to drive that en- gagement rate is good." In the final question and answer ses- sion, a questioner targeted Fallon and Reliant, saying it's very different for smaller and mid-sized companies to engage actively in planning health care benefits programs. Przesiek replied that managed care, which requires members to stay within a proscribed physician network or pay a surcharge, rather than direct care, in which they can pick any provider, can result in a significant cost savings, and that a third of Fallon's commercial business is directed to restricted network pro- viders. One more questioner, who said she worked for a company with less than 15 employees, said that when rates were not state-approved until very late in the process, her company saw a 30 percent increase. "How could we be able to get a sense of how things will happen? We're in technology and competing with large companies. And benefits are an attractive [recruitment tool]. We're in a big pool." Przesiek responded: "Even if you don't have rate information, contact your legislator. We need to fix that. ey are hearing from us. ey need to hear from you." n

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