2009 Benny Awards Benefits Leadership in Health Care
Robert Goodman
Health Benefits Manager
Manatee County Government
Bradenton, Fla.
When Robert Goodman got word that he had won a Benny Award in the category of Benefits Leadership in Health Care, he didn't know what to think. He had never heard of a Benny Award.
"I went on the Internet and said, 'This is some crazy scheme,'" says Goodman, who is the health benefits manager for Manatee County Government in Bradenton, Fla., which is about 50 miles south of Tampa.
But Goodman's accomplishments leave no room for doubt. As manager of the health benefits program for 3,300 government employees and their dependents, he has designed and implemented in-house health and wellness programs that have led participants to adopt healthier lifestyles and to make better health care decisions. The result: healthier employees and lower costs.
Offering workers 'Your Choice'
An entrepreneur at heart, Goodman started one of the first third-party administrators in the 1970s. He retired in the 1980s, but came back to work in 1993 to advise Manatee County on its health plan. The county ended up hiring him full-time.
In 2000, Goodman started work on a new wellness and preventive care strategy for the county. The new model was intended to make employees more accountable for lifestyle choices while reducing medical benefit costs and increasing productivity. Meanwhile, Goodman was skeptical of the new consumer-driven health plans that were emerging in the marketplace.
"I did not feel that consumer-driven plans were going to solve the problem of reducing health care costs," says Goodman. "It was just going to shift costs from the employer to the employee."
Goodman decided a fair way to reduce health plan costs would be to base benefits on lifestyle choices that were within control of employees and their dependents. In 2006, Manatee County debuted its "Your Choice" health benefit plan, with three tiers of benefit coverage in a high-deductible plan depending on the lifestyle choices of participants. The "Basic" plan features a $1,000 deductible and a coinsurance structure. The "Better" plan has a $500 deductible and coinsurance. The "Best" plan waives deductible and co-insurance requirements, asking participants to make copays instead.
To get into the Best plan, adult participants must complete a health risk assessment, a biometric assessment and a wellness exam. They also may be required to complete other exams or to attend workshops depending on age, gender and known health risks such as diabetes and nicotine addiction. Smokers, for example, attend a smoking cessation program. To get into the Better plan, participants still have to do the health risk assessment, biometric assessment and wellness exam. To get into the Basic plan, they don't have to do anything.
Fully 93% of Manatee County's health plan participants meet the requirements to maintain the Best plan, with the remainder evenly split between the Better and Basic plans. Only a few employees resisted the launch of the "Your Choice" plan.
"When I gave my talks about it, I had people ask, 'Are you a communist?'" says Goodman. "Those were the real die-hards." Other than that, he says, it was clear that "people wanted to make a change."
As a result of the "Your Choice" project, the county merged its employee assistance program and behavioral health care plan. Four onsite managers run the new program, called the Lifestyle Assistance and Management Program or "LAMP."
"We did not go outside to the private sector," says Goodman. "We hired everyone locally." LAMP, as the program is known, integrates all wellness programs, including nutrition, diabetes, exercise, and chronic disease management.
Merging the EAP with behavioral health, says Goodman, is an efficient approach to helping employees. Under the old plan, he says, participants were often shuffled from EAP counselors to psychologists to psychiatrists. "They kept spilling their beans to everyone and no one's getting any better," says Goodman.
Under Goodman's direction, Manatee County also integrated behavioral health with its wellness and disease management programs. Employees who enroll for a nutrition class, for example, are required to go to a behavioral health class as well.
"We saw that if you wanted to lose weight or stop smoking, there was more to it than just doing it," says Goodman. "There had to be a willingness to change."
The Manatee County health plan is run entirely in-house with 18 full-time employees, most of whom are contractors. Three registered nurses run an onsite medical management program that assists with medical weight-loss programs, pain management, and cardiac health. A diabetes management program, staffed by a registered dietician and certified diabetic educator provides one-on-one coaching and free glucose test strips and meters. The county also has a clinical pharmacist and an exercise specialist on site.
Health plan employees handpick the doctors in the health plan network. Some 600 doctors in Manatee County belong to the network. Nearly all health plan participants (97%) use in-network doctors, says Goodman.
A six-week "exercise basics" program, developed in-house at Manatee County, attracted 85 enrollees within minutes of being launched on the Internet, and the number of participants has since grown to 566.
Results
The "Your Choice" plan has yielded noteworthy results. The plan's bariatric surgery program, for example, was highlighted in the journal Disease Management and Health Outcomes. Participants in the program lost an average of 157 pounds at 24 months post surgery. They reduced their body-mass index by an average of 10 points. Many were able to reduce or discontinue medications for hypertension, diabetes, and high cholesterol. Per-member per-month drug costs in this group dropped 40%, while post-surgery claims dropped 20%.
Other results from various plan initiatives include:
* The diabetes management program led to a reduction in diabetes-related hospitalizations from $500,000 in 2005 to between $60,000 and $70,000 every year since.
* The LAMP program showed an 8% decrease in pharmacy claims for antidepressants, a 17% decrease in hospital admissions related to depression, and a 32% decrease in per-member per-year costs related to depression.
* The 134 people participating in the "Lighten Up" weight management program lost a total of 998 pounds.
* Generic drug use increased from 59% in 2007 to over 67% in 2008.
* Total medical and pharmacy costs increased by only 2.9% from the fiscal year ending 2007 to the fiscal year ending 2008.
"Our cost trend is minus this year," says Goodman. "We're running anywhere from four to eight points minus from the previous 12 months. Our drug costs are basically flat, at a one to two percent increase per year."
For 2011, Goodman plans to add a fourth tier to the "Your Choice" plan. On top of all the current requirements of the "Best" plan, it will require participants to be non-smokers.
The two best things about his job, says Goodman, are flexibility and working closely with health plan participants.
"I like the room to be creative and not to be locked into a box, which health care has been locked into for years," he says. "Too often, change has been addressed by shifting costs rather than by addressing issues. The second thing I like about my job is that I get to see the people I'm helping. The staff feels that way too." -E.B.N.
Jill Elswick, a former EBN associate editor, is a freelance writer based in Roanoke, Va.
