Fujitsu has put a healthcare trust at the heart of its health and wellbeing strategy. Owain Thomas finds out why it has chosen This over PMI and what benefits it brings.
- Fujitsu uses a healthcare trust to keep better control over scheme management and cost
- It has expanded the benefit schedule while witnessing minimal levels of medical infl ation
- The scheme dovetails with other healthcare benefits and supports business objectives along with employee health
Fujitsu takes the health and wellbeing of its employees seriously. The UK arm of the global technology giant has about 14,000 staff based in more than 250 sites across the country - with roughly 20% based at home.
So providing the best healthcare service it can for them is not an easy task. Instead of using typical private medical insurance (PMI), the company has had a self-funded healthcare trust scheme in place for more than a decade and, despite
reviewing it along the way, has never really felt the need to move away from it.
UK and Ireland head of wellbeing David Brackwell has responsibility for overseeing the healthcare trust scheme and believes it has some key advantages over typical PMI.
"The healthcare trust works on two levels and there are two customers in my mind when I think about the private medical scheme we operate," he explains. "One is the business, and the business wants to provide a benefit that is a real benefit for people who work for it. But it wants to provide it in a cost-effective way.
"So the solution is a trust, as opposed to a traditional insured mechanism where you pay a premium. If the claims experience is bad, then the insurer struggles; if the claims experience is good, then the insurer benefits. With the trust model, you are in control of that expenditure, in partnership with your administrator. And it means that you can manage your costs much more effectively. So from the point of view of the business, it should be more effective and our experience is that it definitely has been."
A little less inflation
Medical inflation is one of those topics that typically draws the ire of PMI scheme
sponsors. An annual increase of 8% to 12% is often quoted, but individual schemes can see increases lower than this, albeit still well above the national inflation rates. In contrast, healthcare trust schemes, when properly managed, can see very little increase over a period of several years, something the Fujitsu one has done.
Part of this management process comes from the flexibility of healthcare trusts - this can benefit the employees and sponsoring employer.
"Rather than having an imposed set of benefits and rules (because most insurers will tend to have a fairly generic model), we as an organisation, in partnership with the administrator, can choose different benefits. For us it might be very important to have a particular benefit - so we can build that in. And as long as we are following trust law, where the guiding principle is that a benefit is for the whole membership rather than a particular group, then we can do that," Brackwell says.
"We have had, over the past few years, minor revisions to our benefit schedule,
where we have improved benefits to the membership. For example, we have
significantly increased the amount of benefits someone can have if they happen to be going through the NHS. So if someone is referred by their GP to the NHS pathway, they still benefit from our scheme because we pay them an amount per night or per day of admission.
"And we have increased that figure because it reflects the fact that if someone
goes into an NHS trust, your relatives have to visit or you might want to get various facilities while you are in there. So what we are doing is reflecting the fact that there is a cost there that people may incur, and we increased that benefit level."
Taking this approach can help drive certain behaviours in staff and also prove
cost-effective to the scheme - all while ensuring the best care is still provided.
The NHS benefit payment is lower than it would cost for a private hospital stay,
but it means employees are able to use their local hospital where possible and
still receive some benefit from the scheme, without significantly pushing up the
overall cost of running the scheme.
But Fujitsu has gone a step further than this. It is pushing the scheme to help tackle the pressing issues of the workforce from day one in an attempt to cut absence rates and also give staff the care they need as quickly as possible.
"We recently introduced self-referral physiotherapy. If you are gardening or playing football at the weekend and you twist your ankle, you have work on the
Monday. In that case, going to your GP or A&E can be a challenge, so people tend to defer that - and the longer you leave a condition, the worse the outcomes can be sometimes," explains Brackwell.
"So to get a referral to the scheme for physiotherapy, they simply pick up the telephone and they will get a call back - typically within the same day. They will get an assessment by a chartered physiotherapist and will then either be referred for physiotherapy or given advice on effective self-treatment, because with some conditions there is a lot of self-help."
Using this system means workers get fast access to physiotherapy when necessary
and are not put though unnecessary examinations when it is not. And doing so has helped to keep costs under control while still maintaining a largely uncapped benefits schedule.
"That's great for the members but is great from a business point of view, too. One of the biggest causes of absence in most businesses is musculoskeletal disorders. So if we can get people in to see a physiotherapist early, the results are better and, typically, they are able to continue working or back in work quicker, than if they are waiting for a referral, an appointment, or an NHS treatment of that
nature. So we believe there is a business benefit," Brackwell adds.
This does, however, sound like the controversial pathway or open referral approaches being used by many insurers. Has the trust scheme simply set up a series of referral pathways to cut costs and send members down a rigid route when an issue appears? No - quite the opposite, in fact. While a benchmarked fee schedule is in place, staff may go to any doctor or medical practitioner they like in the country, provided they can cover any cost over the fee schedule. And funding has even been provided for treatment abroad if there is a belief that is the most appropriate route.
The only restriction is the scheme does not cover accommodation costs - but otherwise that is regarded in the same way as a UK consultation.
One open referral policy has been put in place for certain mental health conditions (stress, anxiety and depression) - more in recognition that many GPs around the country are often not familiar with the best specialists to refer to than as cost control.
"What we have done is identified a provider of psychological services that
effectively has a network of psychologists across the country," Brackwell continues.
"And we do tell individuals to go to their doctor and ask for an open referral for psychology. That goes to scheme administrator WPA and they will then link the individual with a psychologist local to them. So we have confidence that they go to a network that we know to be credible and have governance in place, and we simply help facilitate that. But that is not a cost management mechanism; it is simply there to help our employees identify the right resource."
The scheme is open to all employees and everyone is eligible for the same benefits through it, regardless of seniority or experience with the organisation. However, it is funded by a mixed model; some people in the business will get levels of private medical cover as a contractual benefit, others will get partial cover and can trade up, while those with no company contribution can buy in using the company's flexible benefits programme. And there is no initial excess or shared responsibility.
Communicating with a diverse and widespread workforce is always tricky but Brackwell has used many different tactics. The main campaign takes place at the
time of the flexible benefit enrolment window in November, but there is also a
vast array of information on the company intranet, while travelling health fairs
have been run across the country over the past three years by the firm's principal health providers.
"We have seen two things from that," Brackwell says. "One is a very positive
employee reaction - they have the chance to understand the benefits and work out what is best for them. We think we are providing better information for people so they make more informed choice. And we have also seen an increase in take-up due to the fact that we have gone out and educated people."
For smaller sites where a full health fair is not realistic, HR staff have been briefed about health and other benefits and then gone out and delivered the core information and answered any questions. Part of Brackwell's goal has been to build closer links, a strategy that will include cross-referrals, between all Fujitsu's healthcare providers. This became a crucial decision when Fujitsu re-tendered for the healthcare trust's administration provider in 2009 - eventually deciding on WPA.
"Initially, this did take more time to administer," he notes, "but as we have established working parameters and working relationships that are effective, the scheme does not draw a lot of management time from us.
"One of the things that has been a part of my brief is to actually build synergy
across our health service providers. Our occupational health provider is able to
refer someone directly into the private medical scheme without sending that
person back to the GP to get referral.
"Another example would be counselling. We do have a psychiatric and a psycho-therapeutic benefit in the medical scheme. But for a lot of people, just access to counselling can be really beneficial in the first instance. So someone could ring the private medical scheme if they are in distress and not quite sure where to go. They would be referred to the employee assistance programme, rather than talking about psychiatric benefit, which might not be appropriate for someone who is simply in distress at that point in time. We are using our benefits more effectively and more cost-effectively."
A crucial part in evaluating whether this is money well spent is feedback from employees. Statistics compiled by the scheme administrator indicate that employees have a positive view of the service provided and complaints are few and far between.
Indeed, personal feedback is often very positive, with employees writing to say how good their experience was. Some of these stories are published in newsletters and elsewhere within the organisation as a way of further communicating the value of the benefit. But as Brackwell concludes, it is the flexibility of the healthcare trust scheme that has made much of the support possible.
"Certainly, our experience over the past few years is that we have kept the business happy because we have kept the trust fund under effective management. There are lots of things where we have controlled cost, but without detriment to the member, who ultimately pays for the service, either through tax or directly," he says.
"Our experience with the membership is good, generally speaking. We have not reduced our benefit schedule - we have actually enhanced it slightly - so I think those are real positives."
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Respondents say they should only be required in certain situations as the system is not broken.