Disease Management Important to Controlling Health Benefit Costs

Employers reported certain diseases/conditions have a big impact on health plan costs.

More than nine in 10 organizations offer at least one physical wellness initiative, according to the Workplace Wellness Trends 2017 survey from the International Foundation of Employee Benefit Plans (IFEBP).

On average, organizations have had their programs in place for 7.6 years. Three-quarters indicated they offer wellness initiatives primarily to improve overall worker health and well-being, while one-quarter aim to reduce or control health-related costs.

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The survey found the conditions having the greatest impact on employers’ health plan costs are diabetes (41%), cancer (33%), arthritis/back/musculoskeletal issues (32%) and obesity (29%). Respondents commonly offer disease management programs (48.1%) and case management (39.6%), a patient care model focusing on coordinating medical services for individuals.

The top barriers for implementing wellness initiatives include:

  • Workers finding time to participate – 39%;
  • Dispersed worker populations – 27%; and
  • Keeping momentum going – 26%.

Three-quarters of respondents use some type of wellness incentive, including gift cards and non-cash incentives.

Employer wellness initiatives typically utilize a number of internal and external staff that assist in wellness program operations. Internally, they use benefits staff (75%), human resource representatives (49%), a committee devoted to wellness activities (45%) and organizational leadership (42%). Externally, they use insurance providers (49%), benefit consultants (46%) and wellness consultants (37%).

Most organizations with knowledge of the return on investment (ROI) of their wellness programs have found between a $1 and $4 return per dollar spent, with an average of $2.28. Ninety-two percent state their wellness efforts are a success.

Organizations use a variety of methods/factors to calculate ROI on wellness programs, including:

  • The use of health risk assessment (HRA)/screening condition/risk trends – 29%;
  • Factoring program expenses into their calculations – 29%; and
  • Total health plan cost trend lines – 21%.

Responses to the survey were received from 530 IFEBP members, including 431 responses from U.S. employers and 99 responses from Canadian employers.

Morningstar Tool Weighs Investment and Billed Plan Expenses

For the most part, the investment management expenses plans pay are significantly greater than additional billed expenses, and are generally between 85% and 90% of the total cost of the plan.

Paul Ellenbogen, head of global regulatory solutions at Morningstar, says the latest cost benchmarking solution from his firm will supply “valuable baseline information when comparing a qualified plan with a possible individual retirement account (IRA) rollover.”

The firm argues this type of analysis is critical because 404(a)5 disclosures “remain tightly guarded by plan recordkeepers and are difficult to access for plan participants and their would-be financial advisers.”

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“The need to deliver best-interest advice is top-of-mind for advisers and financial institutions, specifically when helping investors determine whether to remain in a qualified plan or perform a rollover distribution into an IRA,” Ellenbogen explains. “Guidance from the Department of Labor states that in the absence of actual plan data that was reasonably attempted to be obtained, the financial institution and adviser can rely on alternative data sources, such as the most recent Form 5500 or reliable benchmarks on typical fees and expenses for the type and size of plan at issue. FINRA and the SEC have also issued guidance when assisting with rollover distributions to an IRA.”

To assist with the process, Morningstar initially built a solution that “surfaces available Form 5500 data.” But the firm is now extending that solution by creating “Qualified Retirement Plan Benchmarks,” which have been designed to help “determine baseline cost estimates, with approximate total fees based on plan asset size.”

As laid out by an accompanying Morningstar analysis, the total costs paid by participants in a DC plan can be broken down into two primary components—investment expenses and additional expenses.

“Investment expenses are the costs associated with investments available to participants in the plan,” Morningstar clarifies. “Many investments also contain some amount of monies that are used to cover plan expenses and are commonly called ‘revenue sharing.’ If the revenue sharing dollars available are not enough to cover the recordkeeping fees, administrative fees, trustee fees, etc., these additional expenses need to be paid by either the plan sponsor or billed to the individual participants.”

The research team finds that, for most plans, the investment management expenses are “significantly greater than additional billed expenses,” and are generally between 85% and 90% of the total cost of the plan.

“There has been an increasing movement among plan sponsors in recent years away from using investments that provide revenue share (e.g., to R6 share classes) and therefore we expect the relative portion of expenses billed to participants to increase,” the firm points out. “It is worth noting that just because the costs billed to participants increase does not mean the total plan costs increase. In theory, higher billed costs should be offset by lower revenue share expenses therefore lower investment management fees. In practice, cost structures vary significantly across plans and providers.”

The analysis shows total plan costs vary materially by plan, but tend to decrease as plan size increases.

“There are some very inexpensive small plans, however,” Morninstar says. “For example, there are some plans with assets of approximately $1 million that have total expenses of approximately 0.25% of plan assets (which would be $2,500 a year). The low overall cost can be attributed largely to the plan sponsor selecting low-cost investments (e.g., index funds) and likely paying directly for all administrative, recordkeeping, and trustee expenses. In contrast, there are some plans with $1 billion in assets with fees approaching 100 basis points. These plans likely rely on significantly higher cost investment options (e.g., actively managed investments), or more expensive share classes.”

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