What should Mr. Arnold consider the key takeaways in the HEP plan when training new employees? Is Mr. Joseph correct that the plan will increase his costs? Additionally, what should Mr. Arnold tell Harry, a diabetic employee who is starting at his department?
Case Study: Implementation of Connecticut’s Health Enhancement Plan
Mr. Arnold is a bridge safety supervisor for the state of Connecticut. He has worked in many regions throughout the state and relies on state insurance plans for coverage. Within the past few years, he sustained an injury on the job and, while at the hospital, was diagnosed with COPD, after many years of smoking. He has begun paying closer attention to his health, but he still requires multiple medications and physician visits throughout the year.
The year is 2010, and Mr. Arnold has heard that, starting next year, Connecticut will implement the Health Enhancement Plan for its state employees. The program follows V-BID principles by lowering patient costs for certain high-value primary and chronic disease preventive services and coupling services with enrollment requirements.
As Mr. Arnold reads the informational booklets provided by the state, he discovers that HEP is unlike previous plans he has known in that it requires members to receive certain services, including preventive care office visits and age-appropriate screenings, to remain enrolled in the plan. The plan encourages better management of chronic conditions and aligns with existing incentives by offering services in the form of free physicals, two free dental cleanings per year, and appropriate diagnostic tests. Members who choose not to participate in the services are unenrolled from the program and assessed a premium surcharge of $100.
Employees with at least one of the specified chronic conditions (asthma, COPD, diabetes, heart disease, hypertension, or hyperlipidemia) are eligible to participate in disease-management programs and offered chronic care appointments with $0 copay. To deter enrollees from using emergency departments for care that could have been provided in less expensive urgent care or primary care facilities, HEP features a $35 copayment for emergency room visits, but the copay is applied only when “reasonable medical alternatives” are available.
Mr. Arnold is asked by his supervisor, Mr. Joseph, to train new employ[1]ees on the basics of the new HEP plan. Mr. Joseph, a healthy individual with no chronic conditions, is worried that these plans will create confusion for his employees and increase his own healthcare costs.
Case Study Discussion Questions.
- What should Mr. Arnold consider the key takeaways in the HEP plan when training new employees? Is Mr. Joseph correct that the plan will increase his costs? Additionally, what should Mr. Arnold tell Harry, a diabetic employee who is starting at his department?
- In drafting your response, think about the population and health of state employees. Do these factors affect HEP plan profitability? Why or why not?
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