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OP-ED | Value-Based Health Benefit Is Nothing To Fear

by | Jun 14, 2011 3:27pm
() Comments | Commenting has expired
Posted to: Opinion

State of Connecticut union employees face a critical decision as they prepare to vote in the coming weeks on an agreement between the Malloy administration and state labor leaders that is projected to save $1.6 billion over the next two fiscal years.

There is a lot at stake for employees, their communities and for our state.

To compound the pressure, there are conflicting reports about the benefits and risks of the health enhancement program under consideration as part of this agreement.

Some employees are understandably questioning what choice is best for them and their families.

As confusing as the changes may seem, the new health program is actually very simple. It offers the same quality health benefits currently provided, but now employees may receive financial and physical rewards for using those benefits.

I have a unique perspective on the proposed health plan. For more than six years, I served as the state Healthcare Advocate, fighting for consumers unfairly denied the treatment or coverage that they needed and deserved. Now as state comptroller, I serve as both the chief fiscal guardian and I administer the state employees’ health care system.

Under the new health program, these responsibilities unite – because the plan promotes both personal health and fiscal prudence.

It helps our workforce to live healthier lives. It helps us avoid needing – and paying for – more costly care by identifying medical issues early through preventative care and better management of chronic conditions, which, left untreated, are costly and compromise our quality of life. The program will save money for taxpayers, but also for employees who already contribute toward premiums and their health care.

As employees consider this plan, I want to dispel some of the top misconceptions that have emerged:

Misconception #1:  This health plan creates a “big brother” or “nanny state” that will monitor and direct what medical care I receive.

Wrong. We won’t know – and don’t want to know – anything about an employee’s personal medical history or health care. Supervisors and co-workers will not have access to private medical information. They will have no role in dictating employee medical care and personal choices.

Patients and doctors will work together to make health care decisions. Doctors will coordinate preventative care – including age-appropriate physicals and diagnostic tests. If an employee already has one of a number of common health conditions, that employee will have the opportunity to participate in a specialized disease counseling and education program with his or her doctor to help maintain and improve health. Patients will make their own decisions with their doctor’s help, just as they do now. The health enhancement program is an effort to ensure that employees receive more information about their health care so they can make informed choices.

Misconception #2:  I will be penalized for being overweight, smoking, drinking or other lifestyle choices.

Wrong. All employees – regardless of lifestyle choices and medical needs – will be offered the same health plan options. The main choice for employees is how much they wish to contribute toward the cost of their care. If an employee agrees to partner with a doctor to maintain and improve health, that employee will actually pay less for more services.

Misconception #3:  I will be forced to undergo a colonoscopy, mammogram or other screenings.

Age-appropriate mammograms and colonoscopies are life-saving procedures. They enable individuals and their families to identify diseases early, avoid more costly and invasive treatments resulting from delayed care and, of course, they help prevent untimely death.  However, there may be circumstances in which a screening isn’t appropriate. In those circumstances, the screening or test will not be required.

Misconception #4:  I will be denied or charged significantly for emergency care.

Wrong. Simply due to lack of communication and awareness, many employees have historically received hospital-based emergency care because they were unaware that the same care was available at smaller urgent care clinics or physicians’ offices. In fact, Connecticut state employees have sought emergency room care at a rate of 30 percent higher than the national average. I hope we can agree that the emergency room is not the best place to get routine or even urgent care.

The new health program seeks to limit excessive and unnecessary emergency room visits. Those who seek emergency room treatment, but are not admitted to the hospital, will still be covered for a minimal co-payment of $35.  If that same care is provided at an urgent care center or physician’s office, only the normal co-payment will apply.

This more efficient care system will provide employees with more prompt and immediate care without the excessive costs and logistics of an emergency room – minimizing costs for everyone, and providing better care for employees.

Misconception #5:  I will be barred from using my local pharmacy and forced to use inconvenient mail order.

Wrong. Those who require maintenance medication to manage health conditions will receive the first prescription fill at their drug store of choice, followed by mail order after that. Mail order will enable employees to receive a 90-day supply of drugs for only one co-payment. This makes it easier to obtain drugs and reduces costs for employees.

There is an acute awareness by both management and labor leaders that there will be personal situations and categories of pharmaceutical drugs that do not lend themselves to a mail order program. Accommodations will be made in these circumstances.

Employees will continue to use local pharmacies for non-maintenance prescription drugs.

Misconception #6: I will be forced to change doctors.

Not true.  Our carriers (United and Anthem) and their provider networks remain unchanged by the agreement. You can continue to see the doctor of your choice from the provider networks maintained by the carriers.

Misconception #7:  They are calling this health enhancement but it’s just the SustiNet proposal in disguise.

Wrong. SEBAC 2011 is a collective bargaining agreement and has nothing to do with SustiNet.

Legislation did pass that will permit towns and later non-profits to purchase coverage as part of a pool that includes the state employee health plan, subject to the agreement of SEBAC. However, the legislation does not change coverage for state employees and retirees and does not place employees into “SustiNet,” Husky or Medicaid.

This type of health care model is fairly new, but not untested. Both private and public employers have similar models – including Connecticut-based Pitney Bowes and King County, Washington.

King County officials have reported saving $26 million since implementing their plan in 2005 – including a savings of $4,315 a year in medical costs, per employee participating in that plan, compared to their alternative option.

In King County, plan participants have submitted more claims for preventative and diagnostic testing, but had fewer claims for emergency, hospital and operating rooms compared to those on the other plan.

Even more compelling, their participants have seen health improvements in several critical areas, including smoking cessation, body mass index, cholesterol, blood pressure, nutrition, alcohol consumption and more. Officials there also report a 6-percent decrease in smoking along with fewer claims for pneumonia, bronchitis and other smoking-related respiratory illnesses.

The hardest pill to swallow in all of this will simply be change. We may be changing the way our state provides health care to its employees – but for the better.

For the reasons above – and many more – the addition of the new health program makes sense for state employees and will improve the health and financial interests of individuals and their families.

Kevin Lembo is the state comptroller.

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Comments

(15) Archived Comments

posted by: StunningContradiction | June 14, 2011  4:54pm

[Misconception #1:  This health plan creates a “big brother” or “nanny state” that will monitor and direct what medical care I receive.]  NOT a misconception.  It *may* be the case that detailed medical information is not shared with the State (our employer), but if NO private medical information is turned over then how will the state know if we’re getting our annual physicals and semi-yearly dental cleanings?  Someone is going to have to pore through insurance information and match it up with specific employees or there will be NO WAY to enforce the agreement to participate in the “health enhancement program.”


Directly from the SEBAC agreement: “There shall be no additional costs to employees from choosing the health enhancement
program, but there will be increased premium shares and a deductible for those who decline to enroll in, or fail to comply with (after appropriate notice), the health enhancement program.”


[Misconception #3:  I will be forced to undergo a colonoscopy, mammogram or other screenings.]  NOT a misconception.  Except for those extremely rare cases that these screenings are contraindicated we are FORCED to get them or pay the $1200/year higher premium and $350 deductible. This fact is clearly stated in the agreement.


Directly from the agreement: [The Health Enhancement Program] “shall include a written
commitment (Attachment Bl) to the requirements of the program in order to be admitted and remain admitted to the program, including agreed upon health assessments and screenings designed to provide early diagnosis and appropriate information to patients so that they and their doctors can choose the best treatment of any illness;”


AND


“d. Participants in the Health Enhancement program will be expected to
participate in the disease counseling and education programs outlined in
Attachment B 3.
e. Participants will also be expected to adhere to the medically approved
schedule for screenings and wellness visits with waiver or rebate of
copayments for such services as set forth in Attachment B2.”


AND


“g. Participants who choose not to adhere to the requirements of the Health Enhancement program will be given appropriate notice and opportunity to
improve. The financial incentives for participation in the health
enhancement program shall be removed from members who themselves or
whose covered dependents fail to comply with the requirements of the
program. They may return to the Health Enhancement Program only upon
coming into compliance and no sooner than the first day of the month
following their demonstration of compliance. Removal from the program shall not, in any case, be based upon the decision of any patient as to the
treatment they receive, or on the progress or lack of progress in the treatment of their illness. It shall not be based on any other factor whatsoever except for the refusal of the patient to get required tests and
screening, and if applicable, to participate in one of the five (5) listed disease
counseling and education programs.”


So, how does the State determine who are the “Participants who choose not to adhere to the requirements of the Health Enhancement program” if they’re NOT getting confidential healthcare information reported back to them?


[Misconception #5:  I will be barred from using my local pharmacy and forced to use inconvenient mail order.]  PARTLY TRUE, state employees are forced to use mail order for maintenance drugs.  As a personal note, the mail order service is NOT inconvenient.  I’ve been using mail order for prescription service for years, even before I was a state employee.


One of my major complaints about this agreement is that in reinforces the FACT that there are different classes of employees withing the unions - something is contrary to the stated philosophy of unionism. If the “Health Enhancement Plan” and all of its requirements are so good for the participants and the State, then why are retirees exempted?  Why are retirees a special class?

Additionally, why are employees that have been here more than 5 years a special class?  As a newer hire I am already paying 3% of my salary into the retiree health plan - until I’ve been here 10 years.  Why does this requirement for employees who have been here more than 5 years take another year to kick in, and then it gets phased in over 3 years?  Why are they a special class?


To paraphrase George Orwell, “We’re all equal, but some are more equal than others.”

posted by: NOW What? | June 14, 2011  6:26pm

Well, I was never really quite able to understand why, up until now, the State couldn’t get an even *better* premium rate on its employees than it (and the HCCC) did. From the SEBAC website:

“Some state employees have wondered how the Health Enhancement Program (HEP) included in the tentative agreement (TA) can both save lives and reduce costs. Consider these sobering statistics, courtesy of an independent actuarial analysis provided the state’s labor-management Health Care Cost Containment Committee:

There were 880 state employees (or retirees) or their dependents treated with chemotherapy for colon cancer in 2005 — twice the national average, primarily because screenings for males is alarmingly low. The vast majority of these cases and deaths are preventable with a colonoscopy.

Based on national statistics, half of these individuals have died in the past five years from colon cancer. That’s approximately 440 state employees who would still be alive had the HEP been in effect and all state employees received a screening.

The drug for treating colon cancer costs approximately $9,500.00 monthly.   That’s over $5 million spent on this one preventable illness alone.

Among the state employee or early retiree female population between the age of 50 and 64, only 2/3 get an annual checkup.

Among the state employee or early retiree male population between the age of 50 and 65, only 1/3 had an annual checkup.”

- Wow. No WONDER the new plan is expected to save money! What people in their right minds WOULDN’T do what they need to do to take care of themselves, ESPECIALLY when their insurance *covers the preventative services*? I personally KNEW one of those male employees who died from the colorectal cancer; I couldn’t BELIEVE he’d NEVER gotten a colonoscopy!

Personally, I believe that employees who DON’T sign up for the new health insurance’s “Health Enhancement Program” should be held responsible for the FULL payment of their ENTIRE health insurance premium, not just the extra $100/month - because by not doing what they’re *supposed* to do, they drive up the State’s (taxpayers’) cost on ALL state employees’ health insurance.

posted by: Frankly | June 14, 2011  9:23pm

Thanks, Kevin.  I hope the various nay-sayers and trolls will now relax and understand that there is no evil plot to turn Connecticut into a Marxist-Leninist collective. 
As a tier 2 state employee with twelve years in the system, I’ve voted “yes” on the concessions; I encourage all my fellow union-members to vote “yes” to a concession deal that is excellent for the most part. (And in this day and age, that’s saying a lot.)

posted by: Pdg | June 14, 2011  10:06pm

I’m really feeling better about the prospects for failure of this deal now.  1st Malloy and the unions issue a joint statement, then this opinion piece…it smells of fear and desperation.  Tell me Kevin, why should I believe anything the state, unions, Malloy or you say when time and again ‘m lied to?

posted by: CovLakeWesty | June 14, 2011  10:35pm

@Pdg - not to burst your bubble, but ... as posted earlier tonight on another thread on this web site ... Our bargaining unit announced their vote today: 1079 for and only 178 against, an overwhelming 86% in favor.  I am thrilled that my fellow members did not act like Sheep and blindly follow the rantings of the “No” brigade.  That’s one unit heavily in the YES column.  Let’s keep the ball rolling.  (and yes, I, as a member, was allowed to watch the vote count occur)

posted by: ... | June 14, 2011  10:38pm

...

Great article Mr. Lembo. I hope this is making the rounds of the CT News websites across the state.

posted by: Pdg | June 14, 2011  11:24pm

To thrilled state employee:  I see you posted on another site as a vo-tech teacher, surprising your union voted yes because the proposal was to eliminate the schools from the state budget and return them to the towns.  My money is on corrections, state police,prosecutors, and judicial marshals.  We shall see…

posted by: StunningContradiction | June 14, 2011  11:50pm

@thrilled - if you really are a state employee, and if you really did watch the vote counting, then you’re a disgrace for announcing the results.  That information should be kept strictly confidential until all the voting is done.  Your announcement (which is probably a lie) is akin to voter tampering.

posted by: NOW What? | June 14, 2011  11:52pm

“StunningContradiction” -

Re: “Misconception #1”: The State IS in fact your actual insurer, because as far as employees’ and retirees’ health insurance goes, the State is “self-insured.” Which for all practical and most simplistic terms. means that the STATE is actually the insurance “company.” This has been the case for quite some time now. So HIPPA has and continues to allow for the sharing of such data with the State and its Healthcare Cost Containment Committee. The proposed SEBAC agreement doesn’t change this pre-existing law, because it is PROHIBITED from doing so by Federal law.

Re” Misconception #3 (and #4, by the way) - You are correct, and Limbo’s statements in hos Op-ed article don’t contradict you.

Re” Misconception #5”: - Again, you are correct - and Limbo’s statemts don’t contradict you.

Re: Yoyr question of “why are retirees exempt” or treated as a “special class?” The FACT of the matter is NEWER and FUTURE retirees are NOT exempted. The OLDEST retirees are exempted (but supposedly can*voluntarily opt-in” simply because of a) the VERY widely-known fact that the older one is (l;ike 65 and up) the HARDER it is to emotionally and psychologically it is to adapt to change in general, ESPECIALLY when it comes to healthcare-related changes, AND (possibly the most important reason) the older one is upon actual ADOPTION of “preventative medicine” strategies, the LESS likely adoption of such strategies is likely to make any real difference in medical (and related economic or financial) OUTCOMES.

As far as your LAST paragraph goes, I *wish* I could answer it definitively but I *can’t*, because I’m not looking at the actual agreement’s details right now and I just don’t have the time to do so (it’s pretty late in the evening right now).

But I hope my responses help you, at least to some degree.

posted by: NOW What? | June 15, 2011  12:44am

“pdg” - As someone who’s NOT directly connected with SEBAC, its member union leaderrship, or State government in ANY way, I look at your comments from *this* perspective:

As an “active” State employee, who would I be *most* inclined to believe? SEBAC, my union, and State officials (on the one hand), OR (on the OTHER hand) the online postings (or offline comments) and incessant rants made by people who a) aren’t necessarily actual State employees, b)  are not only NOT necessarily employees but actually members of extremist right-wing, anti-organized labor organizations (and their supporters) who have a VESTED INTEREST in seeing this Agreement defeated for purposes of furthering their OWN political agendas, and/or c) who MAY be State employees but who seem to have psychological issues of their own that result in their “seeing” all manner of crazy and irrational “conspiracies” EVERYWHERE they look, not just regarding this employee health insurance issue?

Regarding that last one (“c”), REMEMBER - The State’s workforce is SO large that it really IS a “microcosm” of larger society. Consequently there’s BOUND to be a certain - all be it hopefully small - percentage of State employees who share the SAME emotional and/or psychological “issues” that we see in people in society at large. This is a genuinely unavoidable, statistical fact.

LASTLY, please remember that it is UNREALISTIC to expect that all of your local or worksite’s *volunteer* union delegates or stewards (who are rank-and-file employees) would have ALL of the accurate and *detailed* information at their immediate disposal to be able to *accurately* answer EVERYONE’S unique questions and concerns regarding ALL aspects of this SEBAC agreement’s relatively complicated terms. If you sense that they don’t have the accurate and detailed info that YOU need to make a fully-informed choice on how to vote, I STRONGLY recommend that you TELEPHONE your union’s headquarters (office) stating a) who you are, which bargaining unit and local (or “chapter” or whatever) that you’re in AND your specific state agency and work location, b) the *specific* info you need, and c) ask to be connected with the appropriate PAID union representative or official who would most likely be able to provide you with your requested info. If such individual is not available to speak on the phone with you at the time you call, LEAVE A DETAILED MESSAGE for that individual with ALL of the info I just mentioned and ask that they call you back ASAP with the info you need. Whenever I’ve done this I’ve ALWAYS gotten the *exact*, 100% reliable info I’ve needed WITHOUT FAIL, even if it took a few days for them to call me back with it.

Hopes this helps.

posted by: CovLakeWesty | June 15, 2011  9:08am

@Stun - I’m sorry you are upset to see the vote totals, but I am not the one “announcing” them.  Our unit announced them yesterday, and they have been reported online by others.  Apology requested.  And our unit is the third to announce their vote totals, so I guess you should get used to seeing it.  (By the way Pdg, I am not a Vo-Tech teacher.  They have not voted yet.)

posted by: DrHunterSThompson | June 15, 2011  9:22am

The pension changes alone will sink the deal.

HST

posted by: Bill$Ratepayer | June 15, 2011  1:53pm

First vote tallies on Conn. union deal trickle out

Associated Press

June 15, 2011

HARTFORD, Conn.

At least two of the 34 state employee bargaining units have voted to ratify the labor savings and concessions deal reached with Connecticut Gov. Dannel P. Malloy.

The unit representing state police captains and lieutenants posted on its website on Wednesday that members voted 23-12 in favor of ratification. Also, the University of Connecticut Professional Employees Association, with members at all UConn campuses, said in a news release that its members voted overwhelmingly in favor of the tentative agreement: 1,079 to 178.

Kathleen Sanner, president of the UCPEA, says she hopes other state employee bargaining units will ratify the agreement. She says it provides health care, pension benefits and job security for the next four years and workers “can’t ask for more than that in the current economic climate.”

AP-WF-06-15-11 1633GMT

Copyright 2011 Associated Press. All rights reserved.

posted by: the truth | June 15, 2011  3:35pm

Its the beginning of Obamacare.  of course he is for it.  He works for Malloy.

posted by: ohmygoodness | June 15, 2011  5:53pm

@stunningcontradiction: what about the ‘special class’ of our State legislators?!??  No shared sacrifice there! In fact, I heard all they were concerned about was that THEY wouldn’t lose anything in THEIR health care coverage…and they didn’t want to have to start paying for their coverage!!!!  Unbelievable!