Understanding Employee Health Data Can Help Decrease Costs

Data can inform plan sponsors about what benefits to offer as well as how to steer employee use of benefits.

Recent webinars hosted by Benefitfocus discussed links between health and wealth and how plan sponsors are accommodating participants on both fronts, especially during the COVID-19 pandemic.

High-cost health claims can increase an employee’s financial worries. According to Transamerica data, 43% of workers surveyed were distracted by finances at work, with 34% of those workers saying their health had been impacted by financial worries.

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Plan sponsors that discuss these concerns and encourage employees to be healthy add to their bottom line by decreasing employee health care costs, said Jeffrey Caldwell, vice president of strategic partnerships at Transamerica. More than four in five employed adults in its study said they would have a greater commitment to their companies if their employer offered additional benefits to improve their health and well-being.

“It’s becoming increasingly clear that employers that are strategically clear with their health care programs often see dynamic improvements in the workplace,” Caldwell said.

Plan sponsors that focus on health and wealth are often more likely to implement other benefits that they would not have been considered before, including life insurance, supplemental health benefits, and executive and retiree medical and retirement benefits, Caldwell added.

Understanding employee demographics and participant data can also help increase participation in benefits. Employee demographics were the focus of a second Benefitfocus webinar, “Digging into the Data: Case Studies in Controlling Health Care Costs.”

Rachel Uhrig, a senior financial analyst at Assurance Agency, noted that through examining data, her company has found fewer employees are needing emergency care due to COVID-19—down 10% compared with 2019. The company has instead been able to offer and encourage telemedicine. “This is due to a mind shift in going from in-person to online care. People are realizing that we can get the same services online that were once in person,” she explained.

Tamara Warn, a clinical analyst consultant at USI Insurance Services, said she noticed an increase in telemedicine as well, especially for mental health visits. She added that in the data she has seen, more employees are suffering with depression and anxiety, likely as a result of COVID-19. “Some of it is due to people worried about layoffs, if they will go back to work, and a lot of stress and anxiety in that,” she said.

Other companies are leveraging their data to pinpoint which programs best suit their employees’ needs while mitigating high-cost claims. American Eagle Outfitters partnered with Cigna to create a holistic program focused on physical, financial, emotional and social well-being with an emphasis on behavioral health.

Anthony Jarusinski, benefits manager at American Eagle, said the data and onsite health coaches Cigna offered have helped the company identify which health areas to focus on. “We notice if there is an uptick in pregnancy, hypertension, heart disease, etc., and there are programs within our TPA [third-party administrator] to help mitigate risk and high-cost claims,” he said.

Focusing on what the employee demographic is battling now decreases the chance of high costs in the future and reduces stress among employees, Jarusinski added. Because of the program’s success, the company has been able to maintain flat employee contributions throughout the past two years. “Through these programs, we are getting the engagement we need and that is reducing our claims cost,” he continued.

He urged companies to study participant data and offer voluntary benefits, even if the employee workforce seems healthy. As an example, he said American Eagle offers a program that allows employees to test for different genetic diseases, such as high blood pressure, diabetes and cancer.

“If you go status quo and believe that everything is going well, you’re going to be met with some problems down the road as chronic conditions pop up,” he said. “Make sure you have some access to your data to make sure that you know what’s going on with your employee population.”

Settlement Details Published in Norton Healthcare ERISA Suit

The settlement comes with a $5.75 million price tag to be split between the plan sponsor defendant and its financial adviser, along with other nonmonetary stipulations to be followed by both the plaintiffs and the defendants.

Documents pertaining to a newly reached settlement agreement have been filed in the U.S. District Court for the Western District of Kentucky in the Employee Retirement Income Security Act (ERISA) lawsuit known as Disselkamp v. Norton Healthcare.

The claims in the underlying lawsuit resemble those in many other ERISA complaints filed against health care systems and other large employers across the U.S., suggesting that the fiduciaries operating these entities’ retirement plans failed to monitor the share classes of mutual fund investments offered to participants. Other claims in such cases, including this one, suggest the plan fiduciaries failed to substitute less expensive share classes of mutual funds for more expensive ones. The plaintiffs say such actions resulted in defendants wasting the assets of the plan participants, who were forced to pay higher fees than were necessary.

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As noted in the settlement agreement and its accompanying exhibits, Norton Healthcare and the other named defendants—which include service provider Lockton Financial Advisors and its parent, Lockton—admit no wrongdoing and continue to deny the allegations made in the case. However, to resolve the litigation and prevent any and all further claims on related grounds, the defendants have agreed to pay $5.75 million back to the retirement plan in question, along with other nonmonetary stipulations.

As is often the case in ERISA lawsuits reaching such a conclusion, the path to the settlement agreement was far from straightforward.

On August 2, 2019, the court issued a memorandum opinion and order granting in part and denying in part the defendants’ motions to dismiss. Specifically, the court dismissed the plaintiffs’ duty of loyalty claim and struck the plaintiffs’ request for a trial by jury. The court also denied the defendants’ motions to dismiss with respect to all of the plaintiffs’ other claims.

On September 5, 2019, the defendants filed answers to the plaintiffs’ amended complaint, and after the parties exchanged various disclosures, they attempted to resolve the civil action in a private plenary session mediation on February 27, 2020. In advance of the first mediation, the Norton defendants and Lockton defendants provided the plaintiffs with documents they requested, including ancillary plan documents, summary plan descriptions (SPDs), investment policy statements (IPS), trust documents, annuity contracts, investment adviser reports, request for proposals (RFP) documents and more.

At that point, however, the parties were unable to reach a settlement, and so discovery continued until the parties, through their respective counsel, agreed to continue settlement discussions and conduct extensive, arms-length negotiations concerning a possible compromise and settlement of the action. Case documents show this process eventually led to a second plenary mediation session, at which the parties reached an agreement in principle to the terms of the proposed settlement.

As detailed in case documents, one of the terms of the settlement was the dismissal with prejudice of the individually named Norton defendants and Lockton Financial Advisors, which was to occur before the filing of the final settlement documentation. Subsequently, the parties filed voluntary dismissals with prejudice of the individual Norton defendants and Lockton Financial Advisors on December 21, conditioned on complete settlement approval.

In terms of monetary relief, the settlement stipulates that Norton Healthcare and Lockton will each pay half of a total settlement of $5.75 million, which will be used to compensate plan participants who invested in overly expensive share classes.

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