RX for Change: Confronting the health care crisis in Kansas

Dec. 6, 2005

By Sharon Montague

Salina Journal

A year ago, Colleen Hansen was more than 15 pounds heavier.

She was always so tired by the end of her shifts at Salina Regional Health Center, where she works in environmental services, that she dreaded cooking dinner for her husband and two sons.

"I'd go home and collapse," said Hansen, 36, of Assaria.

But participating in the hospital's six-month pilot Employee Health Project changed her life. Hansen learned she was predisposed to diabetes, had high cholesterol and blood pressure and was overweight. And she learned how to deal with those conditions to reduce the chances of future health problems.

"From the minute I filled out that questionnaire, the whole hospital has been behind me, 100 percent," Hansen said. "It's just been great!"

Administrators hope the program is great for the hospital's bottom line, too.

In these days of rapidly rising health insurance premiums, Salina Regional officials see the Employee Health Project - recently extended for a year - as a possible way to reduce employee health care utilization and, in turn, keep health insurance premiums in check.

Rising premiums prompted some employers to increase deductibles, or change insurance carriers. And they've sent cities, counties, school districts and small businesses scrambling for coverage.

The Kansas Association of Counties, which found in a recent poll that health insurance costs were the top concern for county commissioners, is contemplating creating and marketing a health insurance plan.

Even the state is getting into the picture. As part of her health initiative, Gov. Kathleen Sebelius charged the Business Health Policy Committee with creating and marketing a state-subsidized health insurance policy geared toward low-income working Kansans.

An 88 percent increase

Employees at Salina's hospital watched their health insurance premiums increase by 88 percent since 1999. David Moody, the hospital's vice president for human resources, said the monthly premium for a single policy was $219.80 in 1999; that jumps to $414.80 in 2006. The hospital pays 85 percent of the cost of the single policy.

United Benefit Advisors, an alliance of independent benefit advisory firms, surveyed 8,700 employers nationwide and found that average health insurance premiums increased 9.6 percent last year. Average premiums were $327 for single coverage and $927 for full family coverage.

To help reduce costs for the hospital, Moody said, the deductible gradually was increased, from $250 in 2003 to $1,000 for 2006, and changes were made in coverage for pharmaceuticals.

Individuals are asked to pay more for prescriptions, Moody said. And instead of covering whatever prescription drug the doctor orders, insurance companies require patients to try less expensive alternatives.

Moody also hopes that helping employees live healthier lives through the Employee Health Project will, in the long run, yield lower health insurance costs. He was impressed with the initial results of the program.

The hospital has more than 1,200 full- and part-time employees. Of the 96 employees who started the project, 72 completed the post-screening. The results include:

G Three employees were diagnosed with diabetes and enrolled in the hospital's Diabetes Education Program.

G Two employees were enrolled in the hospital's weight management program, and 14 participants lost 10 pounds or more.

G At least 20 employees initiated or added to their medications to address high cholesterol, high blood pressure or diabetes.

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Far-ranging effects

Hansen said the program helped her entire family.

She completed the hospital's six-week Diabetes Education Program and met regularly with a dietitian to learn about carbohydrates, serving sizes and how to control her blood sugar and blood pressure through diet and exercise. She took that information home with her and threw away the sweets, replacing them with fresh fruits and popcorn.

And she prepared meals differently. Her 17-year-old son, Bradley, lost 15 to 20 pounds, and her 13-year-old son, Joseph, and husband, Brian, also have dropped some weight.

"We're all eating healthier foods," said Hansen, who before her participation in the hospital program hadn't seen a doctor since an emergency room visit eight years ago.

She now makes regular visits to a primary care physician, takes medication to lower her cholesterol and hopes to avoid taking blood pressure medication by exercising regularly and improving her eating habits.

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Holding down increases

Officials at Krause Corporation, a Hutchinson manufacturer of agricultural implements, also initiated a wellness program to try to stop the rise in health insurance rates. The company employs 185.

Terry White, director of human resources, said the company's health insurer presented proposals to increase premium rates 15 percent to 20 percent a year in recent years.

"Through negotiations and some cost-containment measures, we've been looking at 5 to 10 percent increases," White said.

The company helps pay employee memberships to the local YMCA and sponsors smoking-cessation classes.

Randall Allen, executive director of the Kansas Association of Counties, said some cities, counties and school districts dropped their former health insurance policies and joined the group policy the state of Kansas offers its employees in an effort to reduce costs.

According to state figures, 46 cities and counties are members of the state's health insurance pool, including Reno County and the city of South Hutchinson. Thirty-five school districts are members of the pool, including the Hays School District.

Marjie Galemore, personnel technician, said Reno County joined the state health insurance group July 1, 2003, after costs under the county's self-insured plan got out of hand. The county's experience has been good, she said.

"Our coverage has been good, the benefits have been good," Galemore said. "I know a lot of people who work other places and they don't have as good of benefits and they pay more."

The county pays the full cost of single medical, prescription drug and dental policies and 75 percent to 80 percent of the cost of family policies.

Not offering anything

The cost of the state policy, though, is too high for the Altoona-Midway School District, which is searching for health insurance coverage after going without for some time.

"We are one of the few districts in the state that doesn't offer health insurance at this time," said Bill Orth, who took over July 1 as superintendent of the Buffalo-based school district in Wilson County.

"Five to eight years ago, the single rate went up to $800 or more a person a month, and the district just couldn't afford it," Orth said.

Employees had dropped out in previous years, he said, because of increasing rates. With fewer people, and sicker people in the pool, premium rates increased even more rapidly, to the point that the school district couldn't afford its share of the premiums.

Orth was superintendent at Baileyville before he moved to Buffalo in southeast Kansas. In that district, he was able to find a health insurance policy that both the district and its employees could afford.

"... Because they had a staff of fewer than 50, they were able to go on the Blue Cross Blue Shield small business consortium," Orth said. "We got not a great plan, but it handled the catastrophic things. That's kind of what we're looking for."

Orth said the last time he looked at the state's plan, it would cost about $580 a month for each staff person - considerably more than the district can afford.

Now, he's soliciting bids from insurance companies for a health insurance policy with a $1,000 deductible, $25 co-pay for physician office visits and some sort of pharmacy benefits. He hopes to offer health insurance to employees next year.

We need some help here

By the end of the year, the Kansas Association of Counties hopes to have the results of a survey being conducted by insurance broker Haake Companies of Overland Park.

The association hired the company after its member counties expressed the need for relief from increasing health insurance costs.

"No one was under any illusion that they would see decreases in costs," said Randall Allen, the executive director of the association. "At best, we thought that, realistically, we could look at stabilizing the cost or at least managing the cost increases."

Haake Companies plans to survey county officials to discern what they want in a health insurance policy. Using that information, Haake will develop a health insurance product that meets the needs of at least some of the counties.

"We just feel an obligation to do something," Allen said.

The state hopes to do something, too, for employees of small businesses who don't have health insurance.

Bob Day, director of the Kansas Division of Health Policy and Finance, serves as an adviser to the Kansas Business Health Policy Committee, which is developing a health insurance option for small businesses.

"Our goal is to reduce the number of uninsured in Kansas, and a large number of those uninsured are adults working in small businesses," Day said.

The committee has $500,000 to offer as subsidies for health insurance premiums, Day said. In addition, businesses that currently don't offer health insurance will be eligible for $70 a month in tax credits for the first year they offer coverage.

As of late fall, though, the committee hadn't decided what sort of a plan to offer.

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The preference is to request proposals from health insurance companies, such as Blue Cross and Coventry.

"We're a little concerned about whether we will get adequate participation by the carriers," Day said. "We hope we can."

The incentive, he said, is that the carriers would enter a market they don't serve, because rising costs forced some small businesses to drop health insurance.

If carriers don't pick up the ball, Day said, the committee could offer subsidies and tax credits to small businesses, and have the businesses find their own coverage.

The committee hopes to begin offering something by next fall and to insure at least 3,000 employees - 1 percent of the estimated 300,000 uninsured people in the state of Kansas.

"We anticipate that, if it is successful and people find that it is something the businesses and the community want, we would try to expand it, if we could," Day said. "This is a place to start."