February is Heart Health Awareness month, but heart care should be a focus every month! Heart disease is the leading cause of death in America according to the Centers for Disease Control. Its impact is costly to all Americans and businesses and deserves appropriate funding.
Some quick facts:
- Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States.
- One person dies every 34 seconds in the United States from cardiovascular disease.
- About 697,000 people in the United States died from heart disease in 2020—that is 1 in every 5 deaths.
- In the United States, someone has a heart attack every 40 seconds.
The financial impact is even more startling: heart disease cost the United States about $229 billion yearly from 2017 to 2018.
The consequence of this benefit not being available is not only a lack of quality heart care but also the possibility that good employees will leave for jobs that do provide healthcare benefits.
Finding Funds for Heart Care
Comprehensive heart care isn’t just treating acute incidents, like a heart attack, but includes cardiac therapies, medications and ongoing monitoring. Health insurance is a lifeline for millions of Americans suffering from heart disease. A substantial number of these individuals rely on their employers to provide coverage. Without this employee benefit, many people suffering from heart disease – or trying to prevent it – cannot get the comprehensive care they to protect their heart. For self-funded companies, healthcare is a substantial budget line-item.
What if your company could fund benefits without taxing the bottom line?
Ensuring that a healthcare plan is not overpaying for medical claims is one way to earmark funds for better heart and healthcare programs. There are two ways to avoid overpaying for heart-related medical claims: make sure they don’t happen in the first place and recover overpaid dollars if they do.
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Preventative Programs for Heart Care
Many programs are in place to help promote healthier living and mitigate the negative outcomes of heart disease. However, these programs – to be fully effective – have a cost associated with them. Yet, the costs of preventative care programs can be outweighed by the savings of not having to fund high-dollar, intensive treatments. For instance, having an annual fitness benefit in a health insurance plan encourages individuals to exercise more, which is good for the heart and can help prevent high blood pressure. Another example is implementing a regular wellness check requirement. These annual risk assessments, when completed, not only reduce premiums for employees but also discover any issues in the early stages, allowing for less expensive interventions to be used before major, more expensive, complications arise.
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Conduct Regular Comprehensive Audits to Recover Overpayments
Each year millions of dollars are overpaid on healthcare claims that are inaccurate. Consequences of these overpayments include:
- Paying more toward plan maximums than required, and thereby reducing the number of claims that may be covered, if not in this plan year, then in the next
- Increased administrative fees for self-funded employers, with the costs passed on to employees in the form of increased premiums or reduced benefits
- Higher out-of-pocket costs for employees
Mistakes happen. In fact, up to one out of every three medical claim submissions has an error. It is the fiduciary responsibility of the entity providing health insurance (for self-funded companies, that’s YOU!) to ensure that the dollars spent are providing the services promised. Fortunately, human resources managers or employee benefits advisors have a powerful tool to help oversee this requirement: comprehensive claims audits. During a full audit, analysts review every claim for errors and assign red flags to those claims that seem illogical. These may be one-off mistakes (typically human input errors) or systemic errors that allow mistakes to repeat themselves, often snowballing and costing companies sometimes millions of dollars in overpayments. Having an annual comprehensive audit increases the likelihood of recovering these overpaid claims and correcting any systemic issues due to errors.
Not Overspending on Healthcare is Good for Everyone’s Heart.
Make a commitment to heart care this month and put in safeguards that will protect your company’s fiscal health and your employees’ health all year long. You can cover both ends of the saying, “An ounce of prevention is worth a pound of cure.” Work with health care insurance providers to implement preventative programs, but when you do have to fund bigger treatments, make sure you aren’t overpaying for the procedure!