Executive Perspectives

P.O. Box 838

2-4 Main Street
Peterborough, NH 03458
Toll Free: 800-258-5318 Phone: 603-924-9449 Fax: 603-924-4490

One in Five Insured

Americans Avoid Seeing a
Doctor Due to Fear of Cost

recent online survey conducted by Harris

Poll on
behalf
of SCIO
Health
Analytics revealed that approximately two
in five insured Americans (38 percent) do
not have a good understanding of which healthcare
services are covered under their current plan. One
in five insured Americans, or approximately 44
million people, have avoided visiting a doctor for a
general health concern within the past 12 months
because of cost concerns.
The online poll surveyed more than 2,000 U.S.
adults aged 18-plus about their general sentiments
around
the Affordable
Care
Act
(ACA) or
Obamacare, healthcare costs and their overall
understanding of the healthcare system, as well as
services covered under their health plan.
Ambiguity and cost fears prevent millions with a
chronic condition from visiting their doctor.
Approximately half of U.S. adults (117 million) have
at least one chronic condition, of which 14 percent
of (or 16.4 million) have avoided a doctor's visit in
the past 12 months because of cost concerns. While
chronic conditions such as heart disease, asthma,
and diabetes are generally incurable, they can be
managed through early detection, improved lifestyle
and treatment.
"These findings are particularly relevant at this time
as millions of Americans are once again deciding
their annual healthcare benefit options through
Open Enrollment," said Siva Namasivayam, CEO,

FEBRUARY 2015:

One in Five Insured Americans Avoid Seeing a

Doctor Due to Fear of Cost

Onsite Clinics Are a Key Component to a

Successful Health Benefits Strategy

Employers Very Concerned About Health Care

Costs More Employees in Wellness Programs

SCIO Health Analytics. "While Americans are

spending more time researching health plans, the
survey reveals a significant knowledge gap in the
specifics of their health care options that may
eventually lead to unnecessary risks and costs."
Namasivayam warned that the implications of these
findings are even more staggering when you
consider treatment costs for Americans with chronic
conditions
are
already
around $277
billion annually. Avoiding medical treatment for
these conditions can lead to an increased risk of
complications,
emergency
room
visits,
hospitalizations, readmissions, work absenteeism
and disability that could potentially drive healthcare
costs even higher and cripple an already
over-burdened system.
When asked how their healthcare situation has
changed since the introduction of the Affordable
Care Act:

41 percent of Americans say they have spent

more time researching what is covered by
insurance plans (either in their own plan or other
plans).
60 percent of Americans say they do not have a
better understanding of the healthcare system

This newsletter is for informational purposes only and should not be considered as legal advice.

AWANE

February 2015

despite the media coverage and public/political

discourse around Obamacare.
Among those insured, 44 percent did not know
the out of pocket costs/co-pay for prescription
drugs, and 61 percent did not know the costs for
urgent care/walk-in clinic visits.

The survey also found that age and gender play a

role in understanding healthcare costs and services.
Among insured adults, 48 percent of those aged 1834 say they do not have a good understanding of
what healthcare services are covered under their
plan, compared to 27 percent of those aged 65 and
older. Younger insurance holders, especially men,
are also much more likely to be cost-conscious
when visiting the doctor. When asked if they
avoided visiting the doctor for a general health
concern in the past 12 months because of cost
concerns, 40 percent of insured men aged 18-34
said yes, whereas 27 percent of insured women in
the same age group responded the same
(compared to an overall average of 20 percent for all
adults age 18+).
While the ACA has encouraged the U.S. healthcare
system to become more consumer-focused, this
study suggests that health plan managers need to
be more aware of the needs of the millions of
Americans who are new to health insurance and
better communicate with more targeted messages
and education around plan coverage and cost.
"It's like buying a car without a manual or taking a
test drive. You are left somewhat disoriented in the
driver's seat," said Dave Hom, Chief Solutions and
Business Development Officer at SCIO Health
Analytics. "Health insurance companies need to
adopt customized solutions based on big data to
understand and reach these new members.
Through the use of segmentation and consumer
data such as medical literacy, communication
preferences and geographic access to care,
companies can find the most effective channels and
messages to educate members on coverage, costs,
and how to get the care they need."

Younger insurance holders, especially

men, are also much more likely to be
cost-conscious when visiting the doctor.

Executive Perspectives

How do Americans want to receive health plan

information? According to the survey:

62 percent (the majority) say they would be

likely to better understand their health plan
information using the websites offered by their
healthcare plan provider.
41 percent would be likely to better understand
their health plan information using member
phone support offered by their healthcare plan
provider.
37 percent of U.S. adults say they get
information about healthcare costs and services
from their insurance company.
31 percent get information about healthcare
costs and services from their doctor.
________________________________________

Onsite Clinics Are a Key

Component to a Successful
Health Benefits Strategy

mployers are increasingly finding the use

of onsite and near-site clinics as a
successful strategy in controlling health
care costs, enabling easy access to
medical services, improving employee health,
enhancing engagement in worksite programs and
ultimately increasing productivity, according to a
survey of 255 employers by the non-profit National
Association of Worksite Health Centers (NAWHC).
NAWHC conducts an annual survey of employer
sponsors of onsite clinics to enable them to
benchmark their operations and policies.
Especially in light of health care reform, onsite
clinics are increasingly being recognized by
employers of all sizes as a valuable benefit to
reduce costs and absenteeism, while serving as the
hub to integrate all worksite programs, and increase

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AWANE

February 2015

employee health and satisfaction, said Larry

Boress, NAWHC executive director. Onsite clinics
are not just for jumbo employers. We found an
increasing number of employers of all sizes are
running these themselves or finding willing partners
among local providers and vendors.
According to NAWHC and other industry research,
the greatest return for clinic value is among
employers who experience high emergency room
use for non-emergency conditions, show high levels
of lost time from unscheduled medical issues, or
have covered populations that show low utilization
of existing primary care, preventive screenings or
condition management programs and services.
Survey findings:

A majority of respondents of all sizes said the

financial objectives for their onsite clinics are
being met, with 64% seeing a reduction in
medical care costs, almost 70% realizing
reduced time lost by employees leaving work
to see outside medical providers, and 63%
had reduced use of the emergency room.
Employers offering clinics are seeing
enhanced integration of health management
services, higher employee engagement in
health management programs, and increased
effectiveness of health promotion efforts.
While most employers do not charge for clinic
services, many are unaware of the need to
charge employees with Health Savings
Accounts a fee reflective of market prices.
Over a third of employers with clinics do not
consider their onsite clinics as part of their
benefits plan, and there is uncertainty in how
to value a clinic for purposes of the ACAs
excise tax computations

Onsite clinics are not just for jumbo

employers. We found an increasing
number of employers of all sizes are
running these themselves or finding
willing partners among local providers
and vendors.

Telemedicine is an emerging trend for many

using onsite clinics, especially in the areas of
acute care, wellness and behavioral health.
Acute care, emergency or first aid, preventive
and wellness are among the top services
offered at employer clinics.
Over 30% of onsite clinics now provide
primary care services and this number is
expected to grow in the future.
Nurse practitioners/RNs and physician
assistants are the main providers for these
clinics.
Over 35% of employers self-manage their
clinics and do not contract with a vendor or
provider to operate the facility or hire
providers.
While most employers contract with third-party
vendors to manage their clinics, an increasing
number of employers are finding partners
among local physician groups and hospitals.
Lessons learned in developing clinics included
the need to promote a clinics confidentiality
and privacy; having providers who relate to
and understand the workplace and its culture;
offering services for free or lower than outside
services; using vendors with state-of-the art
ROI tools; ensuring clinic activities are
integrated with all wellness programs and
vendors; and offering easy access to clinic.

The survey included employers throughout the

United States. Of the 255 respondents, 75% said
they offered some form of worksite health program
or providers are their locations, while 43% indicated
that they have an onsite or near-site clinic. Among
the responding employers, 8.34% said they had less
than 500 employers, 11.67% indicated 501-5,000,
27.5% 5,001-10,000, 20% 10,000-25,000, and
15.83% had more than 25,000 employees.

Executive Perspectives

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AWANE

Employers Very Concerned

About Health Care Costs
More Employees in Wellness
Programs

ccording to the latest Strategic Benefits

Health Care Survey report from the Society
for
Human
Resource
Management
(SHRM), more than three-quarters (79
percent) of organizations that provide health care
coverage to their employees are very concerned
about controlling health care costs. The good news
is that wellness programs and flexible work
arrangements are two of the most popular employee
benefits offered by organizations.
Costs Continue to Climb
Over the past three years, the percentage of
companies indicating that their health care costs
went up has remained about the same, yet high, at
69 percent to 74 percent. To halt some of the
increasing costs, one-half of organizations indicated
that they increased employee contributions to health
care costs in 2014, while about one-quarter (26
percent) of organizations said they planned to
increase employees share in 2015.
A growing number of employers are asking
employees to contribute a larger percentage of their
health care costs, said Evren Esen, director of
SHRMs survey programs. But it is important that
employers fully assess the potential impact of such
a change, especially in todays improved job market.
Shifting health care costs to employees can lower
employee job satisfaction and pose a barrier for
attracting new talent.
Almost one-fifth (19 percent) of organizations that
provide health care coverage indicated that the use
of consumer-directed health plans, such as health
reimbursement arrangements and health savings
accounts, was the most successful tactic for
controlling health care costs. About one-half of
respondents said they utilized health and wellness
educational initiatives (56 percent) and lower-cost
generic prescription drugs (48 percent) to control
costs.

February 2015
offered some type of wellness program to
employees in 2014, an increase from 70 percent in
2012. Also in 2014, about one-half (52 percent) of
organizations provided employees with the option to
use flexible work arrangements, such as
teleworking.
More and more employers are leveraging wellness
programs and flexible work arrangements as part of
the total rewards package that they offer
employees, said Evren Esen. Offering wellness
programs and flexible work arrangements can be an
effective way to recruit and retain talented employees.
Additionally, employee participation in these
programs is increasing. However, employee
participation in flexible work arrangements is
progressing at a slower rate than wellness
programs. More than one-half (53 percent) of
organizations indicated employee participation in
wellness programs increased last year, whereas just
under one-third (31 percent) reported increased
employee
participation
in
flexible
work
arrangements.
It is important to understand the obstacles that may
be impacting employee participation rates in flexible
work arrangements, said Esen. There needs to be
support from management and leadership in order
for more employees to participate in flexible work
arrangements.
The survey also looked at the effectiveness of
wellness programs.

Health Care Costs: Seventy-two percent of

organizations found that wellness programs
were somewhat or very effective in reducing
health care costs in 2014.
Employee Health: Seventy-eight percent of
organizations rated their wellness programs as
being somewhat or very effective in improving
the physical health of employees.
Wellness Incentives: About two-thirds (67
percent) of organizations offered wellness
incentives or rewards for participating in
wellness programs. Eighty-five percent of
organizations indicated that wellness incentives
were somewhat or very effective in increasing
employee participation in wellness programs.

Employees Respond to Wellness

About three-quarters (76 percent) of organizations

Executive Perspectives

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