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Health, Science, Environment

Take five: BJC executive Rhonda Brandon talks medical economics

This article first appeared in the St. Louis Beacon: With the arrival of the Affordable Care Act, the health-care landscape is slowly changing, not only for the uninsured but for health-care providers and their employees. Part of that change was reflected in layoffs earlier this year at BJC HealthCare and more recently in changes in employee health insurance benefits.

June Fowler, corporate and public communications vice president for the company, says “new realities” are growing out of the ACA. Those realities include financial pressure to align benefits for workers with what’s affordable to BJC HealthCare. Another reality “that nobody talks a lot about,” she says, is the ACA’s “goals of employee wellness.”

The Beacon recently sat down with Rhonda Brandon, BJC’s senior vice president and chief human resources officer, to talk about how the landscape of cost, worker benefits and wellness programs is affecting the health-care industry in general and particularly the 27,000 employees in BJC’s 13-member hospitals. The interview has been edited for length and clarity.

People who work in certain industries usually enjoy perks. For example, an employee for General Motors might get a $500 discount on a Camaro. Aside from an employee pension plan, funded by BJC, and benefits, such as 401(k) plans, what has now changed in the Camaro equivalent in the BJC system – a lower worker discount on health care, perhaps?

Brandon: People like to make that analogy that because we are a health-care provider and you work for a health-care organization, somehow there is some free product that’s given to you. If you are an employee and need care or hospitalization, your coverage is provided by BJC. We’re self-insured, which means that we are responsible for all of our (health claims like) medical, prescription drugs and dental. Our employees share in that cost. On the wellness side, however, a number of resources are available to employees at no cost to them. Smoking cessation is one example. Another is on-site health screening at no cost to our employees.

The health-care industry is facing a lot of challenges regarding cost, so we had to look at our entire portfolio. We are making changes across our organization, and our benefit programs are a part of that. It’s not only making things affordable for BJC but also for our employees. What we found was that our cost trends were rising, increasing faster than the national average. We are trying to better align ourselves with what is happening in the market. Many health organizations, as well as external industries, have changed the way they deliver their benefit programs. We’re catching up.

What has catching up meant for health benefits for your workers?

Brandon: We’ve changed our (health benefit) plan structure (to offer two plans instead of three). We used to have a gold, silver and bronze plan. We decided to simplify them to two choices, a choice-plus plan equivalent to the gold plan; and a choice plan that’s pretty much equivalent to the silver and bronze plans because they were similar in cost. We also have a number of employers whose spouses are employed by other organizations that offer group medical insurance. We are requiring that those spouses seek medical coverage with their own employers. They would have to pay an additional premium (if they choose) to remain on our plan. This is standard industry practice. Next, we are changing the eligibility for part-time employees (to those) who work 24 hours a week on average instead of 16 hours. Again, this is an alignment with external practices. We are trying to catch up.

But you say the changes are not only about additional premiums and adding more cost to employees.

Brandon: We are encouraging our employees to take on better health behaviors. We have something called the health-risk assessment. We are encouraging all employees to take the assessment to give us insight on what our health measures are and how we can help our employees live healthy lifestyles and make healthy choices. We have an incentive included in our plan to encourage employees to take an annual physical.

It seems ironic that workers in the health-care industry would need encouragement to get a physical exam in an environment like BJC.

Brandon: We are encouraging people to get their annual physical so that we can identify chronic conditions early or indicators that our employees need to pay greater attention to their health. The annual physicals are free. That’s a benefit we’ve had a long time. We just haven’t had (many) employees take up that option. So we are encouraging them to do so by giving them a credit on their premium for health care on an annual basis. The free physical with their physicians (is followed by) a lot of services supporting the outcomes of those physicals to help employees make better choices.

We are also focusing on tobacco cessation for employees and anybody 18 or older in families of employees, whether they are covered in our health plan or not. Those who stop smoking will not pay as much as our smokers will for their medical benefits.

We know that tobacco use increases health issues. So starting next year, we will no longer hire tobacco users. We are trying to meet the problem on the front end of employment.  

One criticism we hear is that the cost of health benefits will rise for your workers.

Brandon: Premiums will increase by only 2 percent. Let me give you some context. That’s the lowest increase that BJC has offered in several years, and it’s half the national average of 4 percent. We realize we are making a number of changes to our plan, and we wanted to re-balance them to our employees’ pockets by increasing the premium rate by only 2 percent over last year’s rate.

I’ve heard people say, ‘Thank goodness that we still have our employment.’ I am also hearing from those more directly impacted, like our part-time employees. They are concerned about their options. They can join a spouse’s plan, potentially. The insurance exchanges are being set up, and that’s perhaps an opportunity. Some of our part-time employees also are eligible for Medicare. We have been communicating very thoroughly what the opportunities are. But the reactions are mixed, which was not unexpected.

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