An April 11 guest column titled “U faltering on health-care issues” expressed concern about the impact of the UPlan Medical Program, the University’s health-care coverage, on the health and pocketbooks of University employees. Significant changes have been made to the UPlan in 2006. These changes were made with input from the Benefits Advisory Committee, which is composed of representatives from all employee groups. The changes are designed to actively involve faculty and staff members and their families in improving their health and well-being and in becoming partners in controlling the rise of health-care costs.
The success of the UPlan in moderating the trend of rising health-care costs has allowed the University to minimize increases to participants this year and next year. The average employee premium increase for 2005-2006 is 3 percent, with virtually no increase projected for out-of-pocket expenses. When employee and employer costs are added together, spending for health-care coverage for University employees is projected to rise 7 percent – well below what many organizations are experiencing.
This success has been achieved by negotiating to get the best possible pricing on our contracts, using a separate vendor to manage the pharmacy component of the health-care plan and implementing a comprehensive health-improvement initiative called Health Connections.
Continued success in curbing the cost of health care and what University faculty and staff members pay for coverage will require shared responsibility and a partnership of all UPlan participants.
The new pharmacy benefit through RxAmerica is designed to ensure access to needed drugs and supplies while providing an incentive to use more cost-effective treatments. Participants are encouraged to consider generic drugs when filling prescriptions. Increasing the use of generic drugs by UPlan members from 45 percent to the national level of 51 percent will result in cost savings for all UPlan participants. For each 1 percent increase in generic drug use, there is a projected cost savings of $300,000.
For every medical condition for which prescription therapy exists, a UPlan member has one or more quality drugs available at the low $10 co-pay level. When for reasons of medical necessity a participant cannot use what is available in the Generic Plus category, a physician can submit a prior authorization request that enables the UPlan member to continue using the existing prescription at the $10 co-pay level. Participants also have the option to use more expensive drug therapies.
There have been service problems in the pharmacy program, but most have been resolved. We continue to work with RxAmerica to resolve outstanding issues and are confident RxAmerica service will continue to improve.
After the launch of Health Connections, which is administered by Harris HealthTrends, more than 6,300 UPlan members are taking steps to improve their health and well-being. Every employee who successfully has completed the confidential UPlan Wellness Assessment now has a personalized, health status profile and a starting point to achieve better health. Moreover, eight out of 10 employees being invited to enroll in follow-up health improvement programs are signing up to do so.
One aspect of the Health Connections initiative is the disease management program. The goal of disease management is to improve members’ health and thereby reduce the need for more costly critical care. Any employee who has been treated for asthma, arthritis, coronary artery disease or low back pain (or eight other specific diagnoses) is being invited to participate in disease management. The individual UPlan member is encouraged to work with a health coach to improve nutrition, manage medications and handle doctors’ office visits. The member is provided with information needed to better manage his or her illness.
The University fully appreciates and shares our employees’ concern for confidentiality of protected health information. When a participant incurs a claim for services through the UPlan, the University never sees that claim, only a register of payments from the health plan administrators Medica and HealthPartners who need to be reimbursed.
The University authorized Medica, HealthPartners and our previous medical plan administrators to release to Harris HealthTrends the names and claims information of individual UPlan participants so Harris HealthTrends can, in turn, invite University faculty and staff members to enroll in Health Connections. This exchange of information between our contracted vendors is taking place outside the University, is a secure transmission and is in full compliance with the terms of the Health Insurance Portability and Accountability Act. Again, the University does not see claims information.
The University is not faltering on health care for its employees. On the contrary, we are fortunate to enjoy a health plan that provides quality, affordability and choice. Through careful planning and willingness to change, we have minimized cost increases for our employees and kept the UPlan strong. However the rising cost of health care is a national crisis. We must work together with our faculty and staff members to make absolutely sure that our plan does not falter in the challenging years ahead.
We care about the health and well-being of every University employee, and we care about the cost of health care. Changes to the UPlan create a win-win partnership in which employees play an active role in controlling costs by improving their health and well-being.
If you are a University employee and have not already done so, please take this opportunity to complete the online UPlan Wellness Assessment to earn your $65 wellness reward before the April 30 deadline. Visit www.healthconnections.umn.edu to get started. Please continue to participate in our health and wellness programs and partner with us to maintain a stellar UPlan for all University employees.
Dann Chapman is the director of employee benefits at the University. Please send comments to [email protected].
