Wellness, insurance linked in new program
August 1, 1999 4 minutes read
Wellness, insurance linked in new program
Based on a new model of health and well-being
For several years now, insurance carriers and managed care organizations have sought ways to incorporate the concepts of wellness and preventive health into their offerings. But Petaluma, CA-based Elements Inc. has made a better step: Its program was created from scratch with such integration as its founding principal.
Called the Whole Health Program, it combines creative employee health coverage with wellness-based programming and care. Designed to empower employees to take a responsible approach to their own health and well-being, it is based on a new model called The Five Elements of Wellness, developed by the company’s founder and president, Arnold B. Freiman, MEd, MDiv. The elements are:
• Physical
• Financial
• Spiritual
• Self
• Relationship
(A detailed description of the five elements can be found on p. 90.)
A long journey
Freiman’s concept was borne from a wide range of life experiences, including being diagnosed with cancer 18 years ago and becoming frustrated and angry with the health care and health insurance systems. He also founded what he says is the first licensed acupuncture school in America, and later established a naturopathic medical college in California.
As a result of his own experiences, Freiman became a consultant to social services companies, helping the uninsurable. He has also served as a patient chaplain caregiver, and this combination of business and personal experience led to the development of the five elements.
"With the capitated restructuring of health care, we’re saying to patients, Here’s your health plan, don’t use it,’" he explains. "That’s the reason health care costs keep climbing and quality goes down."
What Elements has done, Freiman explains, was create a module that is an educational paradigm. "We seek to engender the trust, education, and caring among employees that the current system can’t by providing many more ways to access health care information than running to the doctor," says Freiman. The program’s components include the following:
• employers custom design benefits and scope of coverage (i.e., Elements will carve out and fund those services that are heavily utilized, such as mental health or vision, to protect the employer);
• non-capitated discount fee-for-service plans (providers are compensated only when they actually see and treat a patient);
• non-gatekeeper model (employees and their families have access to an open national network — networks that have been put together in every state — and can self-refer to specialists and alternative care);
• no deductibles or claim forms;
• 24-hour Nurse Line and employee assistance programs;
• natural pharmacy program, with protocols to educate employees on the wide range of lifestyle-based diseases;
• support of alternative and complementary care;
• access to the Elements On-line Wellness Community;
• monthly wellness newsletter.
Getting started
When companies sign on with Elements, a representative will examine their current health plans, including workers’ compensation insurance, and their wellness programs.
"We perform a needs assessment, ask them how they feel health care should look, given their corporate culture, and then show them how to custom create their package and wellness model," says Freiman.
Employees complete a questionnaire assessment based on the five elements of wellness, and the client then receives a full proposal based on employee interests, needs and learning styles.
"We create a health plan for the year, and a wellness plan for the year," Freiman explains. "If we see specific issues of importance, we create wellness interventions that will be covered by the insurance plan. For example, if we need specific treatments and classes for Type II diabetes, all of that will be covered. If we need smoking cessation classes, the same concept applies; there is no separation between wellness and insurance."
Elements encourage employees to take more responsibility for their own health. A Web site is created for each employer, which includes an outline of the health and wellness plans, as well as a calendar of wellness events. Links are set according to the five elements.
Soon, there will be an interactive human body on the Web site; when an employee puts the cursor on a body part and clicks, he or she will receive information about disease states that can affect that body part.
Empowerment is further encouraged through payroll stuffers, Internet, Extranet, telephonics, and posters. "We keep reminding employees that there are other ways to access information — and we make it fun," says Freiman. "We create games, and structure programs around incentives."
And what of the cost? "Thus far, every group we’ve put in the program has not paid a penny more than they were paying before," says Freiman. The insurance is partially self-funded, with built-in multiyear rate guarantees on premiums, administrative, and all fixed costs. "We also show them up front what the scenario would look like on variable costs, based on utilization," Freiman explains. "If their utilization is in line, their wellness program becomes a negligible cost compared to a traditional plan."
Freiman continues: "If the company truly uses the plan and employees get it, they can save money. For example, they can call the 24-hour nurse line, which is free, and save a needless trip to the emergency room."
[For more information, contact: Arnold Freiman, Elements Inc., 515 B St., Petaluma, CA 94952. Telephone: (707) 778-7159, ext. 201. E-mail:info@ elementswellness.com. Web site: elementswellness.com.]
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