Q&A with Julie Evarts of EHD Insurance

You are a nurse practitioner. Does that shape how you think of wellness?

I worked for years in critical care neonatal and pediatrics mostly, but I spent some time working with adults as well. What I found during that time is mostly that people really didn’t understand the basics of what it meant to take care of themselves. When I started doing this in 2005 and now, fast forward to 2019, not a whole lot has changed in that arena.

Has the wellness field changed during that time?

Yes, the focus years ago was predominately health, and what wellness meant was being physically well. If I went to a business and asked about the social health of the company or emotional health of the employees, people would have looked at me cross-eyed and asked what on earth I was talking about.

In the last several years, there is an expanded definition that is becoming acceptable in wellness. People are understanding that we are looking at employees on the whole. What we have been focusing on is lifestyle medicine—this has the whole wellness world turned on its ear.

How is that reflected in what you provide to clients?

What we have done at EHD and in the general wellness community is merged safety and health management. If people aren’t safe at work—if they lose an eye, they won’t be able to see at home. Or if they are at home and are making really poor food choices and feel lousy there, they will feel lousy at work, too. We believe if we teach them how to make better choices across the board, they are less likely to have bad things happen everywhere.

I work with the risk control team on the safety side, and we roll up our sleeves and do an evaluation to find out what has worked for them, what hasn’t, where they would like to be as an organization and how aggressive they want to be to get there.

Just a couple of weeks ago, we had a safety meeting with an employer, and we talked about accidents and what could have been done to prevent them. We found out a seasoned employee fell over a toolbox and broke his arm. I thought it was odd. This was a solid employee, and the company had a solid safety program. We saw the employee in the hall later, and it turned out he had something going on at home and had a panic attack at work. He was in a hurry to get out of the room, and in his rush, he tripped over the toolbox. I gave him EAP [employee assistance program] information and said they had virtual medicine with behavioral health. It was the perfect example of how someone not being emotionally well can have an accident at work.

Why is a wellness program important for an employer?

If a CFO was noticing areas in a company that were having 10% to 20% increases year over year, they would say they needed to do everything they could to stop the increase in that area. But that’s what’s happening in healthcare and they haven’t done that over the years. They just think, with healthcare, it is what it is.

But health insurance costs are second only to payroll, and we can tackle them. With hard work and investigation, we can look at what is driving claims and what the behavior and culture is within a company. Some organizations are very shy and really want to crawl first to earn employees’ trust. Others want to do a full-court press. For them, we do employee meetings, look at their pharmacy spend, claims spend and work on areas where they have the most claims.

You mentioned earlier that people generally aren’t getting the care they need. Why is this? And how can you change it?

One big issue in wellness is people aren’t getting their age-appropriate physical exams. The thought in the industry is it’s because people don’t have insurance. We work with thousands of employees with health insurance, so lack of coverage is not an issue. You also hear there aren’t enough providers, but in a majority of the communities I work in, that’s not the case either.

I talk to a lot of employees, and one issue is deductibles. Whether an employee has a $1,000 or $500 deductible, if they are a low-wage earner, it might as well be $100,000. They just can’t pay for care, so even if their physical is free, if they find something wrong, they think, “I’m not going to be able to pay to fix it, so why would I even go?”

What can employers and brokers do to bridge this financial gap for employees?

We have wellness programs that are tied to helping fund deductibles as a reward. If they are a self-funded employer, the employer might just write a check for that physical. That way the employee is getting the care they need.

We have also offered a wellness day instead of a sick day. It gives employees a day off to go for physical and dental checkups, and they get it taken care of as a benefit to them. We have found significant success in that. If we aren’t getting employees to care, let’s bring it to them or get them the proper time off so they can get the care they need.

One interesting program that’s out there is a wearable that employees can use to reach a FIT goal to help pay for their premiums. Each day they hit their goal, they earn up to $3. It’s $1 for F (frequency), $1 for I (intensity) and $1 for T (time). It adds up to about $1,094 annually that goes toward their deductible. So, for folks that have a $1,000 deductible and worry they can’t get the care they need, this gets them moving and funds their deductible at the same time.

We have another employer that gives an additional $500 to employees’ HSA or HRA to go toward their deductible if they get their age-appropriate preventive care exam and dental exam, participate in a biometric screening, and maintain or improve their health score.

Instead of just lowering premiums, it seems like employers want to use a reward system to help pay for the cost of care.

It’s more cost effective as they cost shift and move things around. Instead of just giving it to them, they say, “We understand this is important and it’s difficult for you to pay that $1,000. But the only way things are going to get better is if you take care of yourself and get healthier.” And as employees do things they need to do, employers reward them by helping fund their deductible. Employers pay about 70% of premiums, and an employee pays 30% generally. What they are asking them to do to is earn that 70%.

But the carrot incentive isn’t going to work with everyone, correct?

There are always going to be people who are not going to make health changes no matter what the reward is. And that’s fine. And I’m also not so unrealistic that I think there is even a solution to every claim problem.

If you look at an organization’s high-claimant list, you’ll see things like brain cancer and premature triplets and people needing knee replacements. You can’t avoid all things. But there are things there that are simmering and causing those $15,000 or $20,000 claims. If you can manage those that are simmering, that’s going to make a big dent.

Looking at hospital admissions that aren’t in the trauma center, about 70% of patients are there because of lifestyle choices—the choices they make from the time they get up to when they go to bed—that are bad. And it’s not always major things. We are talking about making them healthier by moving 15 to 20 minutes more a day than they have been doing. Decreasing portion sizes and reducing salt or cutting back on sugary drinks. Those kinds of small changes can have a big impact over the long term.

Measuring wellness is a challenge. How do you show employers that making these kinds of changes really does have an impact?

The introduction of data analytics tools makes us able to show that directly. For example, Veris [a consortium of self-funded employers] probably has around 350 participating groups. Of those, about 30 to 35 work with EHD. Last year at renewal, EHD [clients] had 30% lower renewal [premium] rates than the rest of the Veris population because of health management and pharmacy benefit management.

One of our large groups does biometric screening with a company called HealthCheck360. We asked to get their data to see the per-employee, per-month claim costs of people who were participating in the health management program and those who didn’t. That way, they can see the benefit for those who take part. We can directly measure improvements in claim costs. A real game changer in my world is the fact that we can add data and show employers and employees what a difference wellness programs make.