Drug prices, government health programs and medical tests all drive health costs higher. But chronic health conditions account for 75 percent of such costs – and most of those conditions could be prevented if not for tobacco use, inactivity and poor eating.
“It’s not only the drug companies and hospitals and doctors and drug plans,” said Chadd Soto, manager of wellness services at Independent Health. “Ultimately, the individual is the solution to maintaining appropriate costs.”
Soto, 44, of Lake View, is Independent Health’s top pitchman when it comes to recommending ways that Western New Yorkers can take better care of themselves. His latest advice for the health insurer’s subscribers? Try FitWorks Rewards, a collection of incentives that uses raffled gift cards to encourage employer groups and individual policy holders to eat better, exercise more and make primary care doctor visits greater priorities.
The Frontier High School graduate holds a bachelor’s degree in exercise science and physiology from Canisius College and an MBA from Medaille College. He and his wife, Krista, an inside sales rep for a Clarence company, have two sons, Cooper, 21, and Peyton, 11. Soto has led corporate wellness efforts the last two decades for a variety of companies, including with Independent Health the last 3½ years.
Q. How has workplace wellness changed since you started in the industry?
It started out as health fairs and on-site nutrition and exercise education. Going into the mid-2000s, employers wanted to know a little bit more about the health of their employees, so health plans started to include debit cards for doing different activities, as well as the continuation of health fairs and behavioral health changes. From 2010 and beyond, health plans are taking a closer look at getting people to do what they’re supposed to do in the health care system. ...Employers are taking a little bit more of an aggressive approach, linking participation in various programing to premiums or Health Savings Account contributions.
Q. When it comes to carrot and stick approaches, what have you found to be most effective with employees?
The carrot, the reward, will drive a certain percentage of the population, and the more money, the greater percentage of the population you will drive. The problem with that is that many employer groups don’t have a budget to support additional funds for people to do what they’re supposed to be doing, so many employers decided to use what I call a “soft stick,” linking behaviors to contribution levels. Some will reduce their overall contribution and say, “If you do what you’re supposed to do, we’ll pay more.” Others choose to just say, “If you don’t do what you’re supposed to do, you’ll pay a little bit more toward insurance premiums.” What I’ve found over time is that when you do use a soft stick, it absolutely drives a greater percentage of your population with less financial liability at stake for the employer.
Q. How effective has the $0 copay for preventative services that is part of the Affordable Care Act been in driving wellness?
Very important. The medical community has decided there are certain things they want people to do to maintain proper health and Independent Health is a big advocate of driving people to their primary care doctor to quarterback their care. There’s approximately 100 zero copay services that a person can participate in. The primary care doctor is the main source of referral for those. It’s your typical services, such as mammograms, Pap smears, colonoscopies but it goes deeper than that. We know that depression is a major factor in the United States in general, and specifically Western New York, so there are services people can take advantage of that you don’t hear about as often.
Q. What are some others might surprise people?
Immunizations, counseling, various therapies. They’re not mainstream but they’re important to one’s health.
Q. A lot of people think about exercise and nutrition when they hear the word, “wellness.” Is there more to it than that?
Of course. Wellness is much larger but exercise and nutrition are two very important components but the mental health of an individual really drives the total health. If you fix the mind, you can fix the body. If you fix the body but not necessarily the mind, there’s always going to be a gap.
Q. What have you seen in terms of how large and small employers have embraced the changes in the wellness field and Affordable Care Act?
It’s been very positive on the wellness side of things. Large groups, because of the cost factor and how they do business with health plans, it makes great financial sense and from an employer wellbeing perspective to help maintain proper health and assist their employees in understanding and improving their health. On the small group side, it’s equally important because historically many small groups struggled with health and wellness. Health plans didn’t do as much, not because they didn’t want to. But there are hundreds of small groups. They can be two or three people, or 15 people. Independent Health with the program FitWorks Rewards has listened to the small groups. It’s a great program with some transparency – meaning that if people in small groups are doing things correctly from a clinical care perspective, such as going to their primary care doctor and doing preventative services – they are entered into a raffle and it’s an opportunity to win a financial prize. From a lifestyle perspective, if people are doing what they’re supposed to be doing – maintaining an active lifestyle, eating fruits and vegetables, getting their water, maintaining appropriate sleep – we also reward them in a raffle format.
Q. Has research been conducted that shows that companies can save money on health insurance if their employees participate in wellness?
There’s a lot of research out there that says there’s a return on investment. It varies depending on who’s doing the research. It’s contingent on what the program is and what you’re measuring. Not all workplace wellness programs are the same, so it’s not an exact science. I hear there’s studies that will indicate that for every dollar you invest, you can save $2.50. I’ve seen it as high as $7. But it’s a difficult measure because there’s not a lot of consistency in workplace wellness. Many employers do things differently, such as – even here at Independent Health with large employers – every employer has their own personality and what they want to bring to the table. Some employers will say, “Hey, I’m going to reward X amount of dollars if they do to their doctor.” Some employers will say, “I’m going to adjust premiums and contribute to Health Savings Accounts if you go to your doctor, do your blood work, improve your biometrics, participate in community events and participate in on-site screenings.” It’s very challenging to measure this when there’s not a lot of consistency from employer group to employer group.
The research does indicate there’s less of a spend for people who maintain appropriate health overall. Then you can draw reasonable conclusions that people that are doing the right thing cost less. You can’t necessarily break that down from employer group to employer group but overall, studies have shown that maintaining proper health is less of a burden on the health care system.
Q. Have you deduced as a health insurer what is the most cost-effective way to include wellness as part of an insu
Independent Health feels finding a primary care doctor, and rewarding people for going to the well visits and their preventative checkups, not only does it help the individual and the community, but if we have a healthy population because they’re getting appropriate services at the appropriate time, then it’s a potential for flatlining of bending the trend lower in health care costs.
Q. What wellness programs are available to employers and what are the most popular?
At Independent Health, you can go product specific. How we design our products – whether there’s a debit card system for doing the right thing or it’s money back for making appropriate choices nutritionally, to a free gym membership for our Medicare population – there’s a product overlay.
Q. How does the new FitWorks Rewards program fit your equation?
FitWorks Rewards is a program available to all of our small group and individual members. The large group FitWorks is more customizable. The small group and individual market for years didn’t have a wellness solution. Many health plans struggled. What differentiates us is our wellness solution for small groups and individual market. For 100 percent of our population, all small groups receive this benefit. It can be with technology: our FitWorks tool. We have alternative solutions for those who don’t have the technology.
The FitWorks tool is very user friendly. Once you sign in and create a user name and password, you participate in the health care system the way it’s to be used and we autotrack everything for you. When you go to your doctor, Independent Health will provide you credit through your personal Web portal. When you have your blood work done, Independent Health will provide you credit. You don’t have to go to the website and click everything you did. We report it for you. The participant can view the website and watch their improvements over time as they participate in the health care system. Every service they receive, we reward them 50 points. For example, if you go to your annual well visit, you’ll receive 50 points. If you have blood work done, you’ll receive another 50 points. Then you’re entered into a raffle and one time per month we draw 50 names and those 50 winners will receive a $250 debit card geared toward healthy spending.
That’s the clinical approach. The same website also tracks your lifestyle activities. For instance, we have a program that tracks your movement, whether you decide to walk, run, bike or exercise in a gym. Then we get into the nutrition components, too. It’s a combination of tracking and self-reporting. The Web portal syncs up with the most popular mobile devices such as FitBit or Garmin and the list goes on, as well as all the most popular mobile apps. When people hit certain pinnacles, we reward them points and that puts them into an additional, completely separate raffle. If you eat the proper amount of fruits and vegetables, drink enough water, sleep enough hours per night, we’ll also reward you credit for that as well. That is self-reporting. For those who aren’t tech savvy, we have a paper submission they can mail in. On the clinical side, that’s still tracked through Independent Health and we’ll reward you and put you in the raffle regardless of whether you’re on the website or not.