Date: October 5, 2012
Since it was established in 1996, the health benefits package offered to employees by Johns Hopkins through the Employer Health Program (EHP) has changed very little. While introducing minimal premium increases, the health plan has continued to cover 100 percent of the cost of most medical services, even as competing health care systems have shifted to formulas requiring employees to pay as much as 20 percent of their medical care.
As Medicare reimbursements plummet and health care costs soar, however, Hopkins can no longer afford to underwrite the cost of all benefits for the entire workforce, says Hope Marsh, director of benefits and wellness for the Johns Hopkins Health System. What’s more, Hopkins’ mission to provide top-notch medical care in the new patient towers and renovated historic facilities has raised fixed costs because of the expansion of the clinical staff, increased energy needs, and additional construction and debt service.
Starting Jan. 1, 2013, employees must cover more of their health insurance costs as Hopkins begins to use a formula similar to those of its competitors. Changes to the health benefits package include:
- Employees using inpatient services outside of Johns Hopkins-owned facilities will pay 10 percent of the cost of care.
- Some premiums and copays will increase. Others will decrease. New deductible limits will kick in for certain services.
- In January 2014, employees will begin to pay the cost of 10 percent of outpatient as well as inpatient services provided by non-Hopkins-affiliated facilities.
Changes to the benefits package are paired with financial incentives for seeking care within Hopkins. Members who see Hopkins providers and receive care at Johns Hopkins-owned facilities won’t have to pay 10 percent of the cost of care. “Under health care reform, health care dollars being paid out are shrinking, and we want to make sure we get a good share of them,” Marsh says. “It makes good sense to motivate employees to get care at Hopkins. Why should our competitors get our health care dollars?”
The new benefits package is for non-represented employees at The Johns Hopkins Hospital and all employees at Johns Hopkins Bayview Medical Center, Johns Hopkins HealthCare, Johns Hopkins Community Physicians, The Johns Hopkins Health System Corporation, Johns Hopkins Home Care Group, Johns Hopkins International and Johns Hopkins Intrastaff. The changes don’t apply to Johns Hopkins University employees, who have shared 20 percent of the cost of health services for several years.
Featuring in-network and out-of-network options, the new benefits package will replace the “basic” and “premium” plans at Hopkins Hospital and the CareFirst plan at Bayview. In 2013, preventive services such as annual physicals, immunizations and mammograms are fully covered for members who receive care within the EHP provider network and Hopkins.
Shifting a degree of the financial burden by raising co-payments for MRIs, tests and other services is a way to coax employees to pay more attention to the cost of health care resources, Marsh says. Accepting a measure of accountability for the price of medical care may also spur employees to embrace exercise, low-fat diets and other sound living habits that help to prevent costly chronic illnesses, such as diabetes and heart disease, she adds. In turn, a healthier workforce will curtail health care costs for employees and Hopkins.
The online Healthy Rewards program, which pays participants for completing courses on fitness, will re-launch in January in an easier-to-use format requiring increased interactive participation. Other wellness initiatives, including a care management program for EHP members with diabetes and asthma that features free prescriptions, are not well used, Marsh says. “We need to make employees aware of wellness programs in a more organized way.”
An effort to spotlight the advantages of a healthy workforce through system-wide fitness initiatives and awareness campaigns is being planned, Marsh says. Also in the works is a “preferred access” program for employees that will speed appointments with Hopkins physicians.
As changes to the benefits package are rolled out, EHP Medical Director Richard Safeer advocates a “comprehensive, cohesive approach to wellness” across Hopkins. “The first step is for leadership to integrate health and wellness into business processes,” he says.
A practicing physician, Safeer came to Hopkins from a similar position at Blue Cross Blue Shield. He describes his job as “helping leaders across the system understand what they can do to improve the health of their population, both for the sake of healthy workers and for the purpose of mitigating health care costs.”
A healthy workforce is a sign of a healthy medical system, Safeer says, because employees who exercise and eat well are more productive, miss fewer workdays and reduce insurance costs. “We all have a vested interest in seeing each other healthy,” he says, “both as colleagues and as fellow payers into this health system.”
A common commitment to wellness must be a part of any strategy for adapting to the changing health care industry, Safeer says: “If Hopkins wants to be part of this evolution, the first step is to demonstrate that we can control our own health care costs. If we cannot project the image of health, we will struggle to attract business.”
That image begins with a workforce willing to take responsibility for its own health, Safeer says. “We need employees to be a partner as we move forward.”