As health care costs grow, Tom Evans' job as director of benefits takes on added importance. Northwestern has just kicked off a long-term, strategic plan to address recent trends of rising health care costs, which will require all faculty and staff to re-enroll during this year's Open Enrollment period. On top of that, everyone will use new online tools to enroll. "In some ways, my job is like conducting an orchestra," Evans says, referring to the many parts of this initiative. Of course, establishing a new health plan strategy, preparing the communications plan and assembling online resources involves many individuals around the University, and Evans stresses that it's very much a team effort.
He continues to lead the day-to-day operations of the benefits division of Human Resources as the main resource for policy interpretation, regulatory compliance, rate negotiations communications and counseling. However, he has spent the past year working closely with Hewitt Associates in designing and promoting the new health plan strategy, testing it through focus groups and gearing up for implementation.
What are the key issues that led Northwestern to make a change in health care plans?
There is the realization that health care expenses would continue to rise at double-digit rates for the forseeable future. Costs have doubled over the past 10 years, and they'll likely double again in the next five. Neither the University nor its employees can keep pace with that, so we acted to slow the increase for both parties. We also want to provide individuals more tools to manage their own expenses and become better consumers. Under the new plan, Northwestern will continue to pay almost three-quarters of total plan costs.
We've added two new PPO plans, a health savings account and two new coverage tiers that will better match an individual's personal circumstances in life. We're also consolidating the number of HMO's from the current four to two for 2007.
What makes a good health care consumer?
Faculty and staff will need to determine their health care needs, research their choices and weigh out-of-pocket costs against monthly premiums. They should also evaluate the quality of different health care providers, and more qualitative data is emerging. Of course we're also trying to promote wellness and healthy lifestyles, but we'll focus more on that next year after we get everyone re-enrolled.
Have we improved as consumers?
We're getting better, but we're still only scratching the surface. Many people practice smart shopping when they purchase big-ticket items like cars, or household appliances like refrigerators. But we don't necessarily use our analytical skills when we're deciding between an HMO and a PPO or whether to take a brand name drug or generic equivalent. Further, some feel their physician is always right, that he or she is fully knowledgeable of the care needed in a given situation and that there's no reason to ask questions. That's becoming less so with time. And it's all part of being a better consumer.
Is this an unprecedented process of having the entire University community enroll at once?
Yes. I don't think we've ever required everyone to make the decision during Open Enrollment to waive or elect health plan participation. Because there are new and different choices for 2007, we felt it was important to have individuals take a fresh look at their personal situation and what plan best fits their needs. One of the issues we had to think about regarding implementation is continuity of coverage for those who, for whatever reason, do not re-enroll. Would they just lose coverage or have it assigned automatically? We decided that everyone should still be protected from catastrophic financial loss due to health care costs so we'll assign a plan and a coverage tier. However, the assigned plan may not be the best fit, so we are urging everyone to re-enroll, especially those covered by an HMO that will not be offered next year. The online tools, including Self-Service enrollment, along with information sessions, should make it relatively easy for people to sign up.
What do you see when you think of health care insurance 20 years down the road?
I think we may be headed back to where we were 50 years ago, using more of a mix of traditional indemnity plans and catastrophic coverage. That's sort of what the new Value PPO plan offers. We're also looking to take advantage of recent federal legislation to grant tax favored standing to certain features of health plans, such as the health savings account.
How and why did you become a benefits expert?
I'd always had an interest in health care and medicine. My father was an internist and cardiologist engaged with both clinical and academic medicine and my mother was a dietitian. But in observing my dad's work life, I saw that he was often doing hospital rounds and making house calls. And that wasn't what I wanted. I was more interested in the broader health care picture. I obtained a master's degree in health services management and worked as an administrator at Evanston Hospital for 15 years. I didn't want to do that forever, and when I looked for other options I found this job. I've been here for the last 15 years, and it provides continued involvement in health care from a different perspective.
This has to be your busiest time of year, so what do you plan to do when Open Enrollment ends?
Take a deep breath. I'll probably attend some TIAA-CREF and Fidelity client conferences in the spring. Away from work, I'll be watching my son's travel hockey team, my daughter as she graduates from Loyola University in nursing and my son as he attends medical school.