Lifelines
Published: Summer 2007; Vol. 9 No. 2

Getting Laborers, Spouses into Disease Management Programs:

Virtually All Western PA Fund Participants
Provide Requested Health Assessments

“It’s a disheartening fact that few LIUNA members or spouses actually take advantage of the annual physical exam benefits provided by their health and welfare funds,” says Mary Jane MacArthur, Director of the LHSFNA’s Health Promotion Division. “As a result, these participants may not discover health problems until they become serious. This means unnecessary suffering for them and unnecessary costs for their fund.”
 
With an innovative new program that other funds may want to emulate, the Board of Trustees of the Laborers’ District Council of Western Pennsylvania Welfare Fund (WPA) has taken a big step toward solving this problem by getting 97 percent of its participants to complete a voluntary health assessment questionnaire. Based on the results, the Fund’s health care provider follows up and enrolls at-risk individuals in appropriate disease management programs.
 
“People generally just won’t go to the doctor unless they feel it’s absolutely necessary,” says Dennis Sarnowski, the WPA Administrator. “Yet, we know if they wait until they feel sick, it’s already too late. To motivate our participants to talk about their conditions, even if they aren’t at the doctor, we devised an incentive program.”
 
The incentive takes the form of a two-tier benefit plan. Members can choose the Basic Plan or the Premier Plan (see box for out-of-pocket expense comparison). All participants qualify for the Basic Plan but may bump up to the Premier Plan by simply completing an individual Health Questionnaire for the member and the spouse.
 
The questionnaire takes about 15 minutes to complete and can be done online or in written form. It consists of 73 questions about health history, tobacco use, current health conditions, recreation and lifestyle habits, emotional well-being, nutrition, attitudes about behavioral change, clinical measurements and gender-specific issues. All questions are multiple choice.
 
Based on their answers, respondents get a personalized health report card designed to help them discuss their health situation with their doctor. For those who complete the questionnaire online (about 47 percent), the report is provided immediately. Written responders get theirs a few days after mailing in their answers.
 
The WPA initiated the two-tier plan in conjunction with a change in health care providers. The new provider, United Healthcare (UHC), agreed to hire a health communication services firm that prepared the questionnaire and managed the communications program with the fund’s participants.
 
“We started a series of communications about the new plan with our participants in August 2005,” recalls Sarnowski. “After two explanatory letters, we sent the questionnaire. Subsequently, we sent notices to those who failed to complete it. After six months, those who had not completed the questionnaire were notified that they were being assigned to the Basic Plan, reminded of the higher costs involved and encouraged, again, to complete the questionnaire to become part of the Premier Plan. Six months later, we gave them another opportunity. At any time, once they complete the questionnaire, the processing begins immediately to upgrade them to the Premier Plan. Steadily, we’ve built the positive response rate to 97 percent.”
 
Currently, participants are required to fill out the questionnaire only once. At some point, an annual or other periodic survey may be instituted. The Fund decided to require questionnaires from spouses because they represent 40 percent of its costs. Questionnaires for children are not required. 
 
All the information is confidential and goes directly to UHC. It is not available to the Fund’s administration. However, the Fund anticipates one day using data from the survey to guide program design.
 
“Currently, we have aggregate data from UHC that provides the number of participants in various risk categories,” says Sarnowski. “As we get more involved, we hope to develop our plan design and wellness programs to meet specific needs.” He notes that plan participants still do not take advantage of the Nurse Line – an after hours help service – as much as the Fund had hoped. “According to UHC, 60 percent of our emergency room costs could be avoided if the Nurse Line was consulted first.
 
“Change always provokes some resistance,” says Sarnowski, “but we held a series of ‘town meetings’ around our region to explain the purpose and value of the plan and how it would work. Also, UHC agreed to set up a service center just for Laborers in Western Pennsylvania, and we were responsive to phone calls from members who had questions about the program.”
 
Although the WPA established its incentive plan in the context of changing health care providers, Sarnowski is confident that even established providers will be willing to renegotiate based on the WPA model. “Even the Blues are doing it,” he notes. The biggest cost is the communications program, including processing the questionnaires and issuing the report cards. “Make sure you know who is responsible for these costs,” Sarnowski advises, “but the provider should be willing to take on these costs.” 
 
“This is a practical example that works,” says MacArthur. “In the long run, it is going to save money for the WPA and help participants be aware of their health risks. We encourage all LIUNA funds to look into this option.”
 
Fund trustees or administrators who would like more information about the WPA program should contact the LHSFNA’s Health Promotion Division at 202-628-5465.
 
 
 
                                      
Out-of-Pocket Expenses    
 

 Basic  

 Premier
In-Network    
Office visit co-pay          

   $    20   

$    5
Specialist visit

$    20 

$ 10
Individual deductible    

     $ 250      

$    0
     
Out-of-Network    
Individual deductible    

$ 500

   $300
Family deductible 

 $1000 

 $600
     
Retail Pharmacy       
Generics

$    15

$ 10
Preferred Brand 

$    25

 $ 15
Brand Name

      $    40      

 $ 25