Story by Sherry Posnick-Goodwin
Photos by Scott Buschman
There are things that chapters can do to improve health care for their members.
"Shop around for health care," says Ted Bynum, CTA chapter services consultant. "Most of us do more shopping for shoes than for medical care. Know which hospital or physician groups are in your area so that you can be aware of what they are charging - so that you can get the best deals."
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New Haven Teachers Association members work the picket lines. |
In addition, associations should analyze the demographics of unit members - including utilization patterns and claims costs - to find programs that will best meet the needs of that population.
It's important to know who is in your plan, the age groups, what procedures are being performed and what kinds of medication are being used.
For instance, if you have a lot of women of child-bearing age, you want to make sure that you have prenatal care and a "well baby" component in your plan. Medical costs are very high for preemie infants and for children who don't get regular checkups. If your demographics show you have an older population, make sure you have a wellness program for adults and lots of screenings for blood pressure, diabetes, cholesterol, etc. Those who don't take care of their health will have higher costs in the long run.
Because 20 percent of those in a health plan typically are responsible for 80 percent of the costs, associations should look at the type of claims that are filed. For instance, if claims filed reflect cardiac, diabetes or respiratory problems, programs that could best benefit members might focus on smoking cessation or obesity.
"The whole thing is about outcomes," says Bynum. "Find programs to help outcomes and reduce costs. We have had screenings and immediately had to put people in the hospital. We have saved their lives and reduced costs by catching problems early. It's better to have free tests and pay for members' checkups than to have to pay for treatment. Also, health care providers may be more than happy to put on a free health fair for your members if they are asked to do so."
Sending newsletters or brochures that explain about health and wellness programs can be helpful, along with educating members about causes of the current health care crisis, cost containment strategies and negotiations. Also, surveying members about their level of satisfaction in a health plan may result in members being more willing to switch plans and cut costs.
Keeping members informed and staying on top of the changing health care crisis were beneficial to the Montebello Teachers Association, which formed an insurance committee of teachers, administrators and clerical workers - all of whom had previously sat at the negotiating table.
"We act as a watchdog committee," says MTA high school representative Pat Bayha. "We have nipped a lot of things in the bud. By looking at trends, you can avoid disaster before it happens. You have to watch things month by month because if you wait a year or two, it becomes too complex."
"When it comes to negotiating, it's best to push for more money in health benefits during each round of negotiations so you don't get way behind and have to catch up as health care premiums continue to escalate," says CTA Negotiations and Organizational Development consultant Marty Kahn.
"Putting health benefit dollars on the salary schedule is generally not a good idea. As health care premiums increase at rates double or triple the regular rate of inflation, the salary dollars used to pay for benefits lose value very quickly."
Kahn advises carefully evaluating any proposal to put benefit dollars on the salary schedule. CTA's Negotiations and Organizational Development (NOD) Department has put out a "Bargaining Advisory" on the issue. [For a copy of the bargaining advisory, call your local staff person or NOD at (650) 552-5395.]
Chapters around the state are already involved in cost-containment strategies that include requesting generic drugs when filling prescriptions or accepting higher co-payments for health plans. While higher co-payments for a doctor's visit can lower the costs of the health plan dramatically, members may object to paying more for visits.
"If you mandate that more people take generic drugs, it can give you a discount," says Bynum. "You don't want to shift the cost from employers to members, but you want to get the best buy for your dollar."
And last but not least, you should always consult with your primary contact staff person before making changes in benefit plans or strategies. An ounce of prevention is worth a pound of cure.
