Health Care Q & A: McClatchy Moves to New Health Care Program in 2006

After several months of reviewing trends and company usage, a recommendation was made to change to one national health care vendor -- Aetna -- and to employ strategies that would target the main driver of health care increases -- the company's claims experience. The groundwork that began two years ago will soon touch the lives of many benefits-eligible employees. In October, many employees will be asked to sign up for one of three new health care plans administered by Aetna. Heather Fagundes, vice president, human resources for McClatchy, recently talked about the upcoming changes.

Q: Why is McClatchy going through this process of changing its health care program?

For several years now, we've been experiencing double-digit premium increases with our health care programs. That's just not something we can sustain long term -- not for the company or for employees who share in the cost of those premiums.

Historically, we've tried to manage increases by changing plan designs or by doing more cost-sharing. It's become clear as we look forward that the best way to control long-term costs is to encourage people to make better choices when it comes to health care and to adopt healthier lifestyles. Healthy people are less likely to incur significant health care expenses.

We also want to reduce the volatility of increases that the papers experience each year. Currently, health care is regionalized, which means that papers in similar geographical locations have similar health care plans and plan designs. When any one region experiences a large number of expensive claims, the rates go up significantly. By putting everyone under one vendor with similar plan designs, we are able to spread the volatility across a much larger group, better control our administrative costs and create more consistency in the benefits that we offer to all benefits-eligible employees.

Q: Why did McClatchy choose Aenta as its new provider?

We were looking for a way to leverage McClatchy's size and buying power. So that meant we had to focus on a national provider, which Aetna is.

Aetna also offers a number of attractive programs that encourage consumerism and help employees make better choices about health care. Aetna has a 24-hour nurse line that provides routine advice as well as a health advocate program that helps manage medical conditions. There are disease- and care-management programs that educate employees about their diseases, help them manage chronic conditions and also help coordinate their care.

Aetna also has very robust web tools, which provide employees with information to make decisions on everything from the doctors that they select to the facility where a medical procedure might be performed.

Q: A lot of companies like McClatchy are moving or exploring a change to consumer-driven health plans. Can you explain what it means to be a health care consumer?

First, it means choosing the appropriate level of care. Many people have a tendency to overinsure themselves. For example, a person in excellent health may choose a more expensive HMO with a very rich plan design that they rarely use instead of a routine care plan that pays less when you see the doctor, but overall may cost less with it comes to monthly premiums plus out-of-pocket costs.

Our routine care plan through Aetna will cover 100 percent of in-network preventative care, will charge a small co-pay for routine office visits, and will offer financial protection through out-of-pocket limits. So that may be an attractive alternative to employees with few medical needs.

Next, consumerism means taking advantage of tools such as online research sites, nurse advice lines and procedure pricing tools to help people make informed, conscious choices about how they use their health care. Often, people with minor health care issues can get the advice they need by calling the nurse line and avoiding a trip to the doctor.

We're not trying to steer people away from going to the doctor, but we do want to provide resources to help them make good decisions. Also, using Aetna's web tools, an employee has the ability to compare both the price and quality rating of different hospitals and procedures. There may be situations where an employee can save money without sacrificing quality of care.

And consumerism means giving people tools to better manage their health. For example, completing confidential health risk assessments helps people understand how they can improve their overall health -- identifying certain risk factors -- whether it be through diet, exercise, stress reduction, smoking cessation or even more sleep.

On average, 30 percent of our employees drive 70 percent of health care costs. If we can change the behavior of that 30 percent even slightly, it could have a significant impact as healthier people are less likely to experience costly medical problems.

Q: Can you highlight some of the key elements of McClatchy’s new health care program?

We'll be offering three plans to employees -- Aetna Select, which is an HMO-like product, Aetna choice, which is a PPO or preferred provider plan, and Aetna Routine Care, another PPO plan.

The reason for offering three distinct plans, which will have three very different cost structures, is to make sure that we offer a variety of programs so employees can choose the one that best meets their specific medical and financial needs.

Again, there will be new programs for disease and care management and a health advocate program to assist employees with taking better care of their health. Care management involves helping employees when they are going through some type of medical situation. For example, if an employee is having surgery, a health advocate might call the employee ahead of time and go through pre-operative instructions and then check in with the employee once they are back home to make sure they understand and are following their doctor’s orders and their condition is improving as expected.

Disease management focuses on disease such as diabetes or cancer where the health advocate can work with employees on education and making needed lifestyle changes. The nurse advocate also helps employees manage their disease by checking to see if they are following their doctor’s instructions and taking needed medication. Having one provider also allows us to collect data on the types of diseases that affect our employees so that we can offer disease-management programs and wellness programs around those particular diseases. It's a proactive rather than a reactive approach to managing health care claims.

Q: When, exactly, do these health care changes take effect?

For all benefits-eligible employees at all our newspapers except the Star Tribune, we'll be rolling out the new program effective Jan. 1, 2006. During Open Enrollment this fall, we'll be asking employees to select their new medical plan and their new doctors, if a new doctor is required. For Star Tribune employees not covered by a collective bargaining agreement, we will roll out the program in 2007.

Q: Does the switch to Aetna mean employees will have to find new doctors?

In some cases yes, and in some cases no. When we evaluated Aenta, we also looked at the overlap between Aetna physicians and physicians in our Blue Shield plans and for most of our newspapers, there was little disruption. However, if a current doctor is not in the network, then we encourage employees to complete a provider nomination form as soon as possible. This form can be found on the HealthWorks web site (http://healthworks.mcclatchy.com).

All employees should be looking at the HealthWorks web site and the Provider Search/DocFind link to determine whether their doctor is an Aetna provider. We understand that there will be some areas where there will be fewer Aetna doctors than others, but our goal is to make sure there is an adequate number of doctors in each McClatchy region. And we continue to work with Aetna on a recruitment campaign to add more doctors to the network.

Q: What happens if someone is in the middle of treatment when McClatchy's health care changes take place?

If someone is in the third trimester of pregnancy, receiving ongoing treatment such as radiation or chemotherapy, or anticipating a surgery or a treatment that will overlap into 2006, we encourage them to complete a transition of coverage request form. We will then work with Aetna and its care management staff to ensure a smooth transition of care from the current provider to an Aetna provider. The form is online on the HealthWorks web site, but if employees have any questions or concerns, they should contact their local human resources department. Our goal is to avoid as much disruption as possible.

Q: How do employees find out if the prescription drug they are taking is covered by Aetna and what do they do if it's not?

If employees go to the HealthWorks web site, they can look on the prescription drug formulary to see if the drug is listed or not. There are certain categories of drugs that will not be listed because we are not covering them such as infertility and erectile-dysfunction drugs. Other than that, if the drug is not listed, it typically will be covered as a non-formulary brand-name drug at a higher co-payment level. We encourage employees to call Aetna member services to ask about specific drugs before they go to the pharmacy to have a prescription filled.

Q: In addition to the HealthWorks web site, how else do employees keep up with the changes?

Most of our newspapers have been holding employee meetings and brown-bag sessions. These will continue in the coming months describing care- and disease-management programs and discussing the concept of health care consumerism. Most important are the upcoming meetings on plan design and employee premium contributions, and we strongly encourage employees to attend. If they are unable to attend, the plan designs will also be accessible on the HealthWorks web site. And, of course, the HR staffs both at the newspapers and at corporate are available to provide assistance and answer questions.