EngageHealth IQ sat down with Jed Constantz, Chief Operating Officer at Employer Advantage Health Care Solutions. Employer Advantage is a Tennessee-based wellness and healthcare services company that specializes in working with self-insured employers with centralized populations and aging workforces. Employer Advantage not only works to reduce healthcare spending for employers, but it also focuses on improving the health of employees, increasing their satisfaction and productivity in the process.

Our Q&A session with Jed shed light on current changes and trends that are happening in the corporate wellness space, and what that may mean for us as physicians, employers, and as individuals receiving care. 

Q: Can you speak to the role of the employer in healthcare reform, and healthcare transformation today? And where does this fit in with the development of wellness programs? 

A:  Improving care management coordination at the primary care level is what is going to improve both the quality and value of healthcare delivery and services.

To support this improvement, a direct connection needs to exist between employers and primary care practices and physicians. Until that type of direct connection is made, more so than what has happened in the past, the healthcare industry will not be as effective or as efficient as it could be, and will continue to be unnecessarily complicated. 

So-called “wellness initiatives need to be embedded in a “clinically valid” primary care setting by the employer so that the patient population has an opportunity to reap the benefit of a program like EngageHealth IQ.

This will allow the insight derived from EngageHealth IQ to be clinically actionable by the patient’s primary care team.

Q: If the wellness programming can better serve people in such a clinically valid environment, is that at all threatening to an HR person? Or what impact does this have on the way things have been done in the past with an employee population?

A: It depends upon the self-interest of that human resources/benefits person. Any time roles and responsibilities are shifted to a more appropriate setting; it could be threatening to the individual or individuals who no longer serve in that role. The same thing holds true for the vendor community who, at present, find it easier to sell to the employer directly, as opposed to channeling their capability through a community based primary care practice.

Unfortunately, not all community based primary care practices are genuinely ready for this conversation or to assume this role and responsibility. Adequate compensation, as a primary care practice, is the biggest obstacle at this time, however, employers are in the best position to address and remove this obstacle.

It is the employer, the CFO, the COO, or at times the CEO, who really has to make the judgment on the value of buying wellness from primary care. Individuals at the HR level often have too many conflicts or issues that they are dealing with that impair their judgment as far as measuring the real value of this strategy. In addition, many lack the authority to make a decision to do the things that need to be done to pull the trigger on this. 

The primary care community has, historically, had trouble advocating its true value on its own behalf. Primary care has not necessarily been ready, but now models of primary care delivery have emerged that are changing their level of readiness.

In the context of EngageHealth IQ, assessing and proactively managing the risk status and risk factors of patient populations has become critical capability for the primary care practices to ensure the more effective, and more efficient, delivery of care. 

Q: What other shifts are impacting this willingness to innovate?

A: The move towards PCMH development, and more recently the growing popularity of something called Direct Primary Care, or DPC, has impacted a willingness and ability to innovate. The DPC model is where primary care practices are carving themselves out of traditional benefit plans, and are offering themselves to employers, using a per patient per month “payment in advance of care” formula. This DPC model recognizes the fact that an employer may have recently implemented a high deductible plan, and offers financial access to primary care before any of the other benefits kick in.

Q: We can see where this is going—if then, the patients decide to deny themselves of care since they have those out-of-pocket expenses. Can you tell us more about the direct primary care style practice?

A: A DPC style practice recognizes that in exchange for a membership fee, they can more efficiently offer a population of patients a wider array of primary care services, particularly preventive carewellness.

They need to be able to offer high value, high profile services to people, so that people believe that they are getting their money’s worth, and are being cared for in the most comprehensive, yet individualized, manner possible.

A growing number of employers understand there is a different breed of primary care practice emerging—and you know they are a different breed because these practices have invested in a system like EngageHealth IQ, and they can demonstrate proficiency in the use of such a system.

Q: What should we know about how some employers are moving to on-site clinics? 

A: There are nearly 1,000 employers throughout the country who have gone the direction of implementing on-site clinics. Typically, they are offered in a limited fashion, and they might be viewed as a source of cheaper primary care, not necessarily more effective primary care.

For those employers that have adopted the on-site strategy, the thinking is in the right direction, but the on-site clinic itself isn’t typically as effective as real primary care. Some on-sites are trying to create their own EngageHealthIQ-like capabilities in an attempt to become more effective.

Rather than reinvent the primary care wheel, employers should consider if there is an opportunity to work with local community-based primary care practices, it may be more efficient and better for the community.

When this happens, it changes the nature of local community based primary care practices for the betterment of the entire community. 

Q: You talk about effectiveness, as well as bettering the community as a whole. Can you connect the dots for us with this and the corporate wellness programming?

A: That’s where the embedding of a clinically valid risk assessment tool, such as EngageHealth IQ, is a perfect example of what primary care practices can do to interact with a person long before the onset of care, and treatment relating to some kind of chronic illness…Wellness programming, at the primary care level can be built on the four “health status” pillars of stress, exercise, diet and sleep. 

The use a tool like EngageHealth IQ can help the practice better understand the needs of the patient, the behaviors of the patient, the mindset of the patient, so now they can intervene early enough and often enough with different types of service offerings. The health education and the literacy of patient—in terms of the health care system—can prevent downstream healthcare spending, which more clearly illustrates the value of primary care, when it is well-structured.

That is really the message we are trying to bring to employers. 

Q: What else would be important for an employer to know—one that recognizes the benefits of a primary care practice that uses EngageHealth IQ for an individualized, comprehensive program they can offer employees?

A: The employer who understands these dynamics, better than most, can recognize, “I can meet the burden of providing first dollar coverage for preventive care in a more selective way, by establishing arrangements with these correct primary care practices”—not all primary care. 

They can see the need for a relationship with a select community of primary care practices that they choose to work with.

Employers owe it to themselves, to their employees, to be more directly involved in this, and when shopping for that correct primary care, they need to look for capabilities like EngageHealth IQ embedded inside that practice.

This represents a type of evaluation standard, because otherwise that primary care practice will talk a good game, but not truly be able to deliver it for that employer’s covered individuals.