October 2007 NewsLetter, "Total Health Management: Putting the Plan's Participants First and Lowering Cost Trends"

Abstract

This NewsLetter discusses limitations of current health care plan designs that point to the need for a new approach that many trustees of multiemployer health and welfare funds are adopting: total health management (THM). Core characteristics of THM are:

  • Promoting healthy behavior to improve treatment outcomes,
  • Encouraging the use of diagnostic screenings and early detection, which can save lives and dollars,
  • Removing barriers to necessary care inadvertently created by aspects of plan design,
  • Encouraging high-risk participants and at-risk participants (i.e., those who have asymptomatic illness or disease) to comply with medical treatment, and
  • Providing participants who need care with information about high-performance, high-quality providers, especially for elective procedures driving a large percentage of plan cost, and access to appropriate care that follows evidence-based guidelines.

The THM approach to cost management is a significant improvement over prevalent health care plan designs because it addresses the root causes underlying escalating medical costs: insufficient focus on preventive care and health promotion, gaps in recommended treatment and poor quality care, including sub-standard care outcomes. It makes the health of participants and their families a clear priority at the same time that it enables plans to begin breaking the cycle of ever-increasing cost sharing and benefit reductions that many have been forced to accept.

Because a THM approach is based on plan-specific data, it takes a different form from plan to plan and is applicable to plans of all sizes. There is also no single "best" place to start. In fact, a THM approach can be implemented in stages. Ideally, a strategic implementation plan will find early cost savings that can be used to help pay for initial and future outlays.

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