As health care costs continue to climb, AaronDavis, president of NextLogical Benefit Strategies in Westminster,Md., is dedicated to helping his clients battle these higher rateswith creative solutions that focus on employee health along withhis full line of ancillary products.

Many brokers tend to take a more reactive approach to managinghealth care. Once the renewals are in, a broker might then look atdifferent employee contributions, benefit plan changes or carrieroptions. However, Davis believes true cost savings come from makinglong-term, sustainable health changes among the employeepopulation.

“We tend to be a very nontraditional firm, and we havenontraditional outcomes and benefits as a result,” Davis says. “Wedecided to take a proactive approach regarding today's health careenvironment. More than half of our staff is made up of health careclinicians, wellness experts, dieticians and behavior modificationexperts.”

As health care costs continue to climb, Aaron Davis, presidentof NextLogical Benefit Strategies in Westminster, Md., is dedicatedto helping his clients battle these higher rates with creativesolutions that focus on employee health along with a full line ofancillary products.

Many brokers tend to take a more reactive approach to managinghealth care. Once the renewals are in, a broker might then look atdifferent employee contributions, benefit plan changes or carrieroptions. But Davis believes true cost savings come from makinglong-term, sustainable health changes among the employeepopulation.

“We tend to be a very nontraditional firm, and we havenontraditional outcomes and benefits as a result,” Davis says. “Wedecided to take a proactive approach regarding today's health careenvironment. More than half of our staff is made up of health careclinicians, wellness experts, dieticians and behavior modificationexperts.”

To Davis, solving growing health care costs through theinsurance carrier is the equivalent of taking a broken car to aninsurance agent rather than a mechanic. A mechanic—not the carinsurance agent—understands how the car works, and the same is truewhen it comes to clinicians overseeing health plans as opposed toinsurance carriers, Davis explains.

“Health care plans are breaking down all over the country from acost standpoint and becoming too expensive,” Davis says. “So why dowe keep going back to insurance people? Why don't we have healthcare clinicians solving this problem?”

Much of the rising health care costs can be attributed totoday's aging population, Davis says. As the population ages, drugspending is grows at a faster rate, and that has a major impact onoverall health care costs.

Disease management compliance is another prominent factor thatdrives up health care costs, which is why NextLogical BenefitStrategies places such an emphasis on employing clinicians. Withclinicians on staff, NextLogical Benefit Strategies can diagnoseplan participants with health risks before the disease becomes toocostly.

Clinicians also are there to help those employees understand howthey can take control of their conditions to better manage thoserising prices.

“When working with an employee population, you have tounderstand how to motivate and support them in order to help thembecome compliant patients,”Davis says. “You need to reduce healthrisks within the population, and that's what we've done. We buildplans that support healthy behaviors and compliance.”

While many employers are turning to high-deductible health plansto control costs, this turns into a compliance issue in many cases,Davis says. HDHPs are supposed to encourage the average planparticipant to become a better health care consumer because he orshe incurs all costs outside of preventive care until it totals toa high amount. This plan might work well for those who are healthyor well-off, but those who are already struggling financially mightbe forced to choose to comply with their expensive diseasemanagement program or buy necessities.

“A large part of our society is living paycheck topaycheck,”Davissays. “When they don't have the money, they aremaking a 'bread or med' decision. If you have a mother at thegrocery store who has to either buy bread or her $300 med becauseshe hasn't met her deductible, bread wins every time.”

Today's health care system is so fragmented that criticalmedical information isn't managed well, especially during thetransition between one carrier and another, Davis says. Often, thenew carrier doesn't have plan participants' records before thetransition, but NextLogical Benefit Strategies' clinicians requestall of the medical information on each plan participant before thechange occurs and delivers the data to the new carrier.

Before the new plan is even in place, the carrier has all of theinformation it needs, allowing for better health management of planparticipants.

“It's sad because you have these people out there who are tryingto fight a disease and need the help,”Davis says. “Then, if youswitch carriers, you have to pick up the phone and initiate theconversation or wait for the carrier to call to find out you needhelp. We don't allow that to happen. We let the carriers know thatwe're not going to wait for them to figure out who those severalhundred people are on their own. They need to know who they are outof the gate.”

NextLogical Benefit Strategies also actively works with carriersto identify plan participants who could use oversight, Davis adds.Plan participants' risk levels are first identified using rawclaims and analytical tools, and then NextLogical BenefitStrategies shares this information with the carrier to ensure theseplan participants are receiving the disease management support theyneed.

To help clinicians and carriers manage plan participants' uniqueneeds, NextLogical Benefit Strategies divides employees and theirdependents into four groups, Davis says. The first group includesplan participants who have been diagnosed and treated for diseases.By organizing these plan participants into one group, theclinicians can ensure the employees are receiving proper care fromthe right provider in the appropriate time and setting at the mosteconomical cost.

“If patients can find the right treatment in those five areas,they will be the least expensive members that they canbe,”Davissays. “We need to make sure all of those components areworking and in conjunction with the medical managers.”

NextLogical Benefit Strategies also creates agroup of plan participants who need a motivational push to undergohealth risk assessments, Davis says.

As part of the Patient Protection and Affordable Care Act andHealth Insurance Portability and Accountability Act, this allowsNextLogical Benefit Strategies to create a physical promotionprogram that offers employees lower health care rates forparticipating in preventive services, such as physical exams.

The third group includes plan participants who are at risk buthaven't developed these potential diseases. For instance, someonein this group may be overweight without any current health issuesbut could be on the path to diabetes or high blood pressure if hisor her patterns don't change.

“We work with this group to conduct biometric screenings andhealth risk programs,”Davissays. “Wellness programs are also reallygood for at-risk people because it has them improving theirlifestyles by becoming more active and going to the gym.”

NextLogical Benefit Strategies also groups plan participants whoare considered healthy, Davis adds.

Although this group doesn't need the same intervention that theunhealthier groups do, NextLogical Benefit Strategies helps developprograms that encourage these plan participants to sustain theirhealthy habits, such as fitness challenges or leadershipopportunities to act as wellness ambassadors.

To help plan participants understand how they can positivelyimpact their health, NextLogical Benefit Strategies sends nursesand dieticians to the workplace to host many educational sessionsthroughout the year.

By doing so, Davis believes this builds trusting and supportivedialogue with plan participants. Each month NextLogical BenefitStrategies also writes four to five fliers in English and Spanishand offers a Web portal where plan participants can learn abouttheir benefits and connect with clinicians.

“We do a lot of wellness plan branding for ourclients,”Davissays “We give them a unique logo and tagline, whichhelps everyone in the company relate to their wellness plan.”

NextLogical Benefit Strategies' emphasis on wellness has been soeffective that some clients have even seen their health care ratesgo down, beating the nationwide trend of skyrocketingcosts,Davissays. In fact, some of NextLogical Benefit Strategies'clients have seen their rates drop as low as 14 percent. This isespecially true among large groups.

For small groups, much of the rate is usually based on theaverage age of the group or location, Davis says. Whether thatgroup tends to be healthy or sick, the rate is the same. Largeemployers, however, are in a different place. Once a group reaches200 employees, the rate is determined by claims history; thus,employee health matters. If a large group is willing to takecontrol of its overall health, it can make a substantial differencein what it pays, and NextLogical Benefit Strategies isn't afraid toget creative in its approach to wellness.

“If you can build a benefit plan that actually encourages peopleto stay compliant with their drugs, get their physical exams, begood patients and participate in wellness, you get people moving inthe right direction, ”Davis says. “That's when your costs startgoing down.”

While the health care market presents plenty ofchallenges,Davisremains optimistic about the future of NextLogicalBenefit Strategies. As employers continue to fight rising healthcare costs and try to understand the impacts of health reform, theyneed NextLogical Benefit Strategies' expertise and guidance.

With NextLogical's team of clinicians and dedication towellness, it's prepared to help clients control their costs andnavigate today's complicated health care system.

Photographs by Brad Howell