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Magazine Jun 4, 2008 - 5:15 AM


Giving medical bills the business

By Bill Squier





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There’s no doubt that the health care industry is big business. A report this past year from the U.S. Department of Health and Human Services projected that, by 2016, health care will have swollen to as much as one fifth of the gross national product. Yet, while more of our dollars are being committed to health-related services, fewer Americans seem to be able to access those same services.

For example, a study by Families USA, a nonprofit health care consumer group, revealed the staggering statistic that in 2006, right here in Connecticut, 1.9 million people between the ages of 25 and 64 had no health insurance. Nearly 150 died because of their lack of coverage. And having insurance is no guarantee of getting the medical care you seek. The Association of American Medical Colleges has been charting a steady decline in first-year medical student enrollment since the early eighties. So, if you happen to find a physician who accepts payment from your insurer, you still may not be able to get an appointment.

Scared?

Virginia O’Neill certainly was when she was diagnosed with breast cancer in 2005. During her very first mammogram, it was discovered that O’Neill had a Stage 2A tumor in her left breast. “This was one big surprise,” she states, and the shock is still evident in her voice three years later. “I thought I was doing everything right.” Instead, she found herself a single woman facing a frightening, debilitating and costly course of treatment. Luckily, her employer was there to help.

O’Neill hastens to report that today she is cancer free and in remission. And she credits Pitney Bowes, where she has worked for the past 20 years, with playing an important role in her recovery. Originally a Stamford native, O’Neill divides her time as a senior accounting analyst between the company’s Shelton office and their world headquarters on Elmcroft Road in the South End of Stamford. It was on-site at one of the Pitney Bowes offices that her cancer was first detected.

“I was scheduled to go to my primary physician,” O’Neill explains. “But, because of an unexpected death in my family, I cancelled everything and never rescheduled. In the fall, I saw an advertisement for a free in-house mammogram. I said [to myself], ‘If I don’t take this chance, I’m never going to do it.’ It was really instrumental in catching the disease early and potentially saving my life.”

Pitney Bowes is, of course, best known for its expertise in the area of communications management — specifically, maximizing the flow of documents, letters and packages from place to place. But, in recent times, the company has become a groundbreaker in its approach to providing its employees with health care.

Founded in 1920, as a manufacturer of postage meters, Pitney Bowes has grown into a firm that generates more than $6 billion in revenue annually in 130 countries. To do so, it employs upwards of 35,000 people onsite at their facilities and in the mailrooms of their clients. That means that, as a self-insured company, Pitney Bowes is obliged to set aside a significant chunk of their yearly operating budget to keep its large workforce healthy and on the job.

Fortunately, the company spent the last decade and a half remodeling their benefits package so that it does exactly that. The philosophy that drove much of the decision-making during those years can be boiled down to a simple, sensible statement of fact: when people are healthier, they are more productive and the cost of their future medical treatments is easier to contain.

The evolution of the Pitney Bowes health care plan began in the late 1980s when the firm’s executive chairman, Michael J. Critelli, was serving as general counsel. “I came to realize that there was a link between good health and reduced disability expenses,” he explains. When Critelli was asked to head up the Human Resources Department in 1990, he tested his theory by analyzing when, where and on what the health care budget was being spent. He quickly concluded that if the company devoted more of its dollars to preventive measures they could slow an increase in medical expenses — one that was threatening to outpace the growth of company profits.

The move proved to be practical for a number of reasons. Faced with rising costs, many other firms had simply shifted more of the responsibility for paying them to their workers. But Mike Critelli felt that if they were no longer able to reimburse employees for 100 percent of their medical bills, the company had better find something to offer in exchange. “A lot of what we did was to keep up the image of Pitney Bowes as a great place to work,” Critelli recalls. “We couldn’t give the rich raises and perks that we used to. One thing we could do was put in the clinics, give people free preventive screenings and introduce immunizations at the workplace.”

The cornerstone of this new approach was the establishment of clinics that could provide much of the Pitney Bowes workforce with basic medical care for free right where they worked. The inaugural clinic was opened in the world headquarters in 1992. The company’s first medical director, Dr. Julian Levine, was an old-school family doctor with deep roots in the community. Having practiced medicine privately in Stamford for more than 40 years, Levine brought a level of trust with him to the clinic that made the employees — some of whom he had even delivered as babies — comfortable enough to give it a try.

“Trust and empathy go hand in hand with good medicine,” Mike Critelli explains. “And Dr. Levine had both in abundance.” The unexpected benefit was that Levine’s ability to connect with his patients frequently resulted in savings to the company. “Very often people would come in with what they thought was a medical problem,” Critelli recalls. “He would zero in on, maybe, a stress-related issue and deal with the root cause. And the medical problem would go away.”

“The onsite medical clinic was critical to me when I was going through four months of chemotherapy,” Virginia O’Neill points out. “I never stopped working. So, when I was tired, I would go to the clinic and sleep. The nurses would give me advice and confidence. They’d say, ‘You’re going to get through this.’ One nurse had worked in oncology. She was very knowledgeable, and I tapped into her as a resource.”

Within a year of opening the first clinic, Pitney Bowes also introduced their Health Care University. The wellness program was intended to nudge their employees into making healthy lifestyle changes. It included 45-minute Lunch and Learn seminars on health issues, participation in other support programs such as Weight Watchers, and information distributed via bulletin boards, printed materials and stop-by booths. HCU also allowed workers to earn credit toward their share of future medical expenses by simply engaging in healthy activities such as exercising in the company’s fitness center. The response was so favorable that HCU was rolled out nationally in 1999.

“I try to work out as much as I can,” says O’Neill of her personal commitment to the goals laid out by HCU. “I do strength training in Shelton and try to arrange my schedule so that I can take the spin class at world headquarters. It keeps my immune system going. If I do have a relapse, it’s important for me to go into anything very strong.” The yoga classes that the firm sponsors at her Shelton office also help O’Neill deal with stress. “The yoga is a way for me to release,” she says.

Despite the careful attention that Pitney Bowes had given to refining their benefits package, the company was still caught by surprise when their health care costs jumped 13 percent in 2000. Dr. Levine’s successor, Dr. John J. Mahoney, tackled the problem by forming an alliance with David Hom, a vice president in the Stategic Human Resources Initiatives Department. Together, they revamped the company’s approach once again by using a strategy they developed and dubbed Value-based Design.

In concept, Value-based Design is as simple as the old adage that “you get what you pay for.” If one prescription or medical provider could be proved to be more effective at treating a specific ailment than another, then Pitney Bowes tried to motivate its employees to use that drug or doctor by picking up more of the tab. The assumption was that if a medical condition could be dealt with in its early stages the employee could avoid far more expensive treatments down the road.

Further analysis of the company’s medical claims also revealed to Mahoney and Hom that a startling amount of money went to the treatment of chronic conditions such as asthma and diabetes. “Having those conditions wasn’t the problem,” states the company’s current corporate medical director, J. Brent Pawlecki, MD, MMM. “It was not being on proper therapy. Or being on proper therapy and not being compliant. So, we changed the whole benefit design to address chronic conditions.”

“We looked at asthma and diabetes for a start,” Dr. Pawlecki said. “And said, ‘If we want to keep people well, let’s take all medications that deal with asthma or diabetes and put them at the lowest co-insurance level.’ People said we were crazy and that costs were going to go through the roof. But what it actually did was keep people on the medications, and out of the emergency room or the hospital. By preventing problems later on, we were actually able to save money.”

The success of Pitney Bowes with asthma and diabetes was expanded to include other chronic conditions, such as heart disease, muscular skeletal disorders and hypertension. With the company’s backing, Mahoney and Hom also collaborated on writing two books that explained their approach (“Total Value / Total Return” and “BeneFIT Design”) so that other businesses could apply the same principles. David Hom was even encouraged to take a 12-month leave of absence to spread the word.

“Nobody has all the answers,” states Dr. Pawlecki emphatically. “So, if there was something that was really good for people, we don’t know why you’d want to keep it quiet. It’s to everybody’s competitive advantage to have a healthier population from which to choose people to hire.”

“Pitney Bowes attracts creative people — people that are interested in doing things a little bit differently,” Dr. Pawlecki adds. “There’s support for trying new things. If something makes sense, you don’t hear ‘no.’ You hear ‘that sounds interesting. Let’s see what happens. Maybe it will cost us money. But maybe it won’t.’”

Though most of Dr. Pawlecki’s time as medical director is spent overseeing the company’s clinical, wellness and pandemic preparedness programs, he’s also been permitted to strike out on his own and has begun to explore the ways in which the corporation might be able to help their workforce deal with end-of-life issues. “All of us will, at some point in our lives, address caring for our loved ones,” he explains. “So, how can we build and design incentive programs and benefits that will help people through a very trying time?”

On an almost daily basis, Pitney Bowes continues to make changes in the work environment that promote what it’s come to refer to as the company’s “Culture of Health.” The fitness facilities and classes are continually updated and expanded. Healthier foods are featured prominently in the company’s cafeteria and vending machines. An employee pharmacy was opened just steps away from the company world headquarters. And, while the buildings have been smoke-free since 1990, the company is working toward 100 percent smoke-free campuses — indoors and out.

Pitney Bowes has even gone so far as to renovate the world headquarters in ways that help their employees fit a bit more exercise into the workweek. “There were no stairwells,” Dr. Pawlecki reveals. “So, we put in a stairwell for people to go up and down to the cafeteria and one at each end of the building. And you’ll see a sign that says ‘take the stairs, you’ll burn this many calories.”

So, if all of these means of improving the health of their workforce have worked so well at Pitney Bowes, why not make them available to the rest of us? Might Pitney Bowes’ benefits plan serve as a model when our next president takes on America’s health care crisis?

Though Mike Critelli is skeptical about the government’s ability to provide universal health care, he does think that it can contribute to reshaping the unhealthy habits of our country’s citizens. “The government can start by creating a level playing field between healthy and unhealthy foods,” he stresses. “They subsidize corn, wheat and sugar much more than they subsidize fruits and vegetables. People living on a low income eat junk food because they can afford it.”

Critelli also feels that much can be done to improve other areas in which the government is already active. “Government could address the shortage of primary care providers,” he explains. “States could fund more nursing training and education. Medicare or Medicaid could do a lot more to improve the process of getting people reimbursed properly for medical expenses.”

And, finally, Critelli sees an opportunity for Americans to take the matter into their own hands via their medical records. Pitney Bowes has formed a consortium named Dossia with AT&T, Applied Materials, BP America, Inc., Cardinal Health, Intel Corporation, Sanofi-Aventis and Wal-Mart to develop a method of delivering secure, convenient electronic access to patients’ health care histories. But the key, from Critelli’s perspective, is making that access available to the patients themselves.

“I believe that it should be used every day to self-monitor health,” Critelli says. “Because of the shortage, we’re going to have to use health care professionals more judiciously than we have in the past. I think the way of the future is a nurse or a doctor that helps people to self-monitor, as opposed to dispensing medicine, treatment and advice.”

A radical idea? Not for Pitney Bowes. In fact, a component of self-monitoring is already part of the company’s Health Care University. “I’ve done the online health risk assessment,” says Virginia O’Neill. “It’s a good reminder of the other tests that I need — like a colonoscopy. I need to make that appointment!”




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