UPMC assesses the most pressing midstate health care needs

Behavioral health, access to health care and prevention are the three most pressing health care needs in Central Pennsylvania in the post-pandemic world.

Tina Nixon, vice president, Mission, Effectiveness and Diversity, Equity and Inclusion, UPMC in Central Pennsylvania, said a health needs assessment outlined what people are facing after being homebound and, in many cases, isolated since the pandemic hit in 2020.

The assessment, which looks at the needs for 2022 through 2025, shows an increase in the need for behavioral health due to mental health issues and addiction.

The study also showed there are barriers to people seeking care as they try to navigate the health care system, and a lack of awareness around programs that offer preventative care.

The UPMC study, conducted every three years, surveyed community stakeholders, patients, community leaders, physicians, the faith community, and anyone using UPMC services, Nixon said.

“We need to improve access to and awareness of mental health services,” she said. The main issues – transportation and a shortage of providers.

“We were able to quickly move to telehealth during COVID so we can offer that platform,” she said. “But there is still a waiting list.”

A state report, conducted by the Wolf Administration, released last week, also showed a need for increased mental health services.

A Behavioral Health Commission for Adult Behavioral Health, established by Act 54 of 2022, which made $100 million in one-time American Rescue Plan Act (ARPA) funding available to support adult behavioral health needs, is charting a path for investments, said Acting Human Services Secretary Meg Snead.

Nixon said the UPMC survey showed the lack of mental health providers is partially because many people changed careers during the pandemic.

The state commission, seeing similar statistics, recommends $37 million should be directed to recruitment and retention initiatives to attract qualified professionals and assist those who do this work, so they are not overly stressed and burning out.

Nixon said UPMC is actively recruiting, letting people know the opportunities that exist both in person and via telehealth. Recruitment teams are reaching into the schools, as early as middle school, to promote the vocation, she said.

“We are not alone. All the (health care) systems in Central Pennsylvania are experiencing this, so the impact is great,” Nixon said. “We have to go above and beyond to attract and retain providers.”

While the state and UPMC, along with others in the field, are looking to recruit providers, Nixon said the demand for services needs to be addressed now. Specifically, she said, the UPMC survey shows a spike in demand from teens and African-Amercian males.

“There has been an overall increase in all populations,” she added, “stemming from isolation and adjustments. The pandemic created the inability to interact with friends and a loss of employment.”

In addition, “People don’t know how to find the resources they need so we have to bring awareness to what providers are available,” she said.

To that end, UPMC is creating a “one-stop shop” by imbedding specialists in primary care facilities and community health clinics.

Providing that service has helped, but Nixon said many people have difficulty getting to the facilities due to lack of transportation, especially in rural areas.

The health system has a mobile unit that travels to those areas offering medical assistance and addiction services. Nixon said they also have coordinated care teams that visit the homebound and those recently released from the hospital.

“Our visit teams provide education, medication and safety checks,” she said. “They also provide a bridge between the time a patient is released from the hospital until their follow-up visit with the doctor,” providing wound care, medication checks and education.

Education, she said, runs the gamut from teaching people to monitor their blood pressure to teaching people how to use phones, computers or tablets for telehealth visits.

“People didn’t go to the doctor during COVID and now that they are seeking care, many are sicker than they would have been,” Nixon said.

“We need to look at ways to address the barriers and we can’t do that alone,” she said. “We have to work with other community organizations to provide all the services.”

Those services include prevention. “We want to promote wellness by looking at health related social needs,” she said.

The health system offers community-based health programs for blood pressure and diabetes care and exercise programs with instructors that look like the population they are working with.

Nixon said the programs are not only informative, but they create connection, reducing the feeling of isolation.

“This is not a one-size fits all issue,” Nixon said. “We need to meet people where they are and provide the services necessary to get them the help they need.”

Companies continue to maintain health plans into the pandemic’s third year 

During the second year of the pandemic, area businesses continued to steer away from making large changes to their health plans while trying to minimize increasing benefit costs for employees. 

This month, the Lancaster-based Central Penn Business Group on Health (CPBGH) released its annual Healthcare Benefits Survey. The survey features participating employers from 86 companies spanning Adams, Berks, Cumberland, Dauphin, Lancaster, Lebanon and York counties. 

The survey found that this year that the average cost for health care coverage was slightly lower for single coverage and slightly higher for family coverage, but both individual employees and covered families paid slightly more for their coverage in 2021. 

“We have been watching health care costs increase for the last four decades – everyone is paying more, yet most of the strategies utilized to help control costs have not worked,” said Diane Hess, advisor to and former executive director of the CPBGH. “I do believe though that being in the middle of a pandemic is not the time to make the drastic changes necessary to affect costs and quality, so I do not expect to see major changes in plan offerings or plan costs next year either.” 

The most prominent way to manage cost among the survey’s respondents was increasing employee premiums with 73% of participating companies noting that they had increased employee cost share for coverage. Hess said that for an employer looking for an immediate impact on the company’s bottom line, increasing premiums continues to be an easy to implement option. 

“Strategies such as employee education and plans to improve employee health through wellness initiatives may or may not have the desired impact and you also do not see immediate results,” she said. 

The average out-of-pocket costs for both a single person and a family were up from 2020 with the average out-of-pocket for an individual being $5,723 and $11,559 for a family. 

The average deductible among the survey’s respondents was $2,315 for an individual and $4,608 for a family. Those deductibles were higher among smaller employers and lower among larger employers with over 200 employees. 

Employers also reported an average medical plan cost increase by 5.07% this year and predict a higher rate of increase of 9.2% next year. 

Lancaster-based High Company’s, one of the respondents on the survey and an employer of over 1,500 people, has managed to avoid cost increases on its health plans since 2019, but is looking at a 4% increase in 2022, said Liz Ford, compensation and benefits director at High Company. 

“For us, [cost savings] is really about understanding our data—it’s a lot of small changes that add up over time,” said Ford. “There is no big magic silver bullet for cost savings for us. It’s about being smart about plan design, prescription formulary and educating employees about where to go.” 

The survey’s respondents employ over 26,000 people. 43% of respondents had between 50 to 199 employees, 27% had between 1 and 49 employees and the remaining 30% had over 200. 

A large majority, 96%, of companies with over 200 employees self-insured their plans. For High, this allows the company to have better access to employee health data. It also means that it is up to the company to educate employees on how to save on out-of-pocket expenses. 

“Like all employers, our deductibles have gotten higher,” said Ford. “Being self-funded, it’s about making them aware of the things they can do to reduce expenses. We communicate to them to get their lab work done in an independent lab and use more virtual care.” 

Employer survey shows continued growth in self-funding, Health Savings Accounts

Pennsylvania’s employers continue to favor self-funded insurance plans and more employers than ever are offering their employees Health Savings Accounts to pay for qualified medical expenses, according to a recent survey.

Harrisburg-based financial advisory firm, Conrad Siegel, recently released its annual Medical and Prescription Drug Survey. The survey was conducted by the firm late last year and was answered by 104 organizations, 82% of which were from the midstate.

While the survey’s results pre-date the COVID-19 pandemic, Rob Glus, a partner and consulting actuary at the firm, said he has yet to see businesses change their health plans as a result of the pandemic.

“A lot of people are furloughing and laying off their employees but the longer this lingers economically, the more chance that there will be for businesses to look at permanent layoffs and bigger changes to their health plans,” he said.

Possibly the biggest change from the firm’s last survey was a jump in the number of employers who said they offered HSAs to their employees, which increased from 32% to 45%. HSAs are savings accounts that let employees set aside untaxed dollars for deductibles, copayments, coinsurance and other expenses.

Glus expects the number of employers offering HSAs to continue to grow since they can only be contributed to if an employee has a high-deductible health plan and the average deductible is much higher than it was years past.

“Now that deductibles are high enough, businesses ask: ‘why wouldn’t I offer an HSA as an alternative to my employees to give them a potential tax savings mechanism to save on their health care?’” he said.

Last year’s survey showed a large jump in the number of employers who shifted from fully-insured arrangements to self-funding — 49% to 58%. This year, that number plateaued at 57%.

Under a self-funded arrangement, an employer takes on more risk by paying the cost of any claims plus an administrative fee.

“Self-funding is a long term play to cut out these administration costs out of your medical program,” Glus said. “If you have the financial wherewithal, it can be a real cost saver.”

The survey also showed that more than half of companies do not offer coverage to spouses who have access to insurance through their employer, and 41% have some form of spousal coverage provisions. If the employee’s spouse still chooses to be covered under spouse’s plan, the average surcharge was $2,551 a year.

“It has always been a struggle for public employers with rich plans,” Glus said. “Everyone else is making changes and if you aren’t, it is too easy to accept all of those people on your plan.”

A smaller change in the survey from last year was an increase in the number of companies offering co-insurance as opposed to copay-based prescription drug programs, meaning that an employee would have to pay a percentage of the cost of a prescription rather than a set copay.