Evaluating Wellness Programs to Ensure Return on Investment

Dr. Joann Schaefer, senior vice president and chief medical officer, recently talked with the Midlands Business Journal about evaluating wellness programs.  Here’s her advice:

“It’s important to have corporate policies supporting wellness at the worksite.  Establishing a tobacco free workplace, incentivizing employees to get their recommended preventive health screenings, providing healthy snacks in vending machines and subsidizing fitness center memberships are a few ways to get started.

Blue Cross uses several metrics to evaluate the success of our program.  We examine the program’s impact on participation/satisfaction, health risk migration, return on investment, job performance/productivity, the corporate culture, health knowledge and medical claims.

Since implementing our wellness program in 2006, tobacco usage has dropped from 20 percent to 8.1 percent in 2015.  Also last year, 96.5 percent of the workforce completed the health risk assessment.

We’re very proud of our efforts and are more than willing to share with others to help improve workplace wellness.”

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.