Issue 14 - Swedish Workforce Gets Failing Grade on Use of its Health Care Plan According to Expert a

Issue 14 - Swedish Workforce Gets Failing Grade on Use of its Health Care Plan According to Expert and Health Care Costs are Unsustainable and Need Immediate Course Correction

On Tuesday, July 19, Swedish invited Randy Axelrod, M.D., a nationally recognized expert on value-based medicine and wellness to present to the Union and bargaining team during negotiations. Dr. Axelrod recently finished a comprehensive analysis of Swedish’s health plan, as well as employee use of the plan. His review included more than four years of medical and pharmacy claims and more than 2,000,000 claims – and the results are startling.

“If I were to grade Swedish employee’s on their use of preventative heath services, I’d give them a failing grade,” said Dr. Axelrod. “In 2011, employees spent more on acupuncture and massage therapy than on preventative care such as mammograms and prostate cancer screenings. Employees simply need to start making better choices with the use of health care resources.”

Dr. Axelrod found that Swedish’s explosive usage trends and overall costs are well above average when compared to other similar plans in our region.

“In my 25 years of evaluating health care plans, I’ve seen only one other company whose costs were as out of control as Swedish,” Dr. Axelrod added. “This is unsustainable and you must make immediate changes.”

In addition, Swedish’s unhealthy workforce is aging (the average employee age is 48), so these problems are expected to get worse, not better over time

Reversing the Trend: Getting Healthy and Reducing Swedish’s Unsustainable Healthcare Costs

Swedish employee healthcare costs are budgeted at about $5-6 million a month. Swedish is self funded which means that we pay for all medical claims including every prescription, doctor visit, surgical procedure, test, etc. Unfortunately, in 2011 our costs have run closer to $8.5 million each month. The main drivers of this explosive increase in cost is high utilization i.e. employees and dependents are accessing services at a higher rate as compared to past years, sub-optimal care delivery and high cost because of late diagnosed cases of cancer and heart disease. If this trend continues, we will exceed our healthcare budget for the entire year as soon as October!

Swedish’s Proposal: How to Course Correct

After Dr. Axelrod’s presentation, Swedish proposed to SEIU that the labor/management benefits committee roll up their sleeves and come up with joint recommendations by the August 23rd bargaining session. The committee will focus on strategies to improve wellness, prevention and disease management, as well as recommendations on how best to redesign the health care plan. The committee will not focus on premium share. Those issues will be taken up with the full bargaining committee.

SEIU President Diane Sosne agreed that she sees opportunity and “low hanging fruit” to work in a collaborative manner to develop a plan redesign that improves our employee’s health and also save costs. She agreed that a wellness program should be an integral part of the solution. We applaud SEIU’s willingness to address these very important issues.

It’s Not a Gag Order

Following Dr. Axelrod’s presentation, SEIU raised concerns that Swedish is restricting employees from talking about union matters. Swedish emphasized our existing policy: employees may discuss matters of personal interest, whether its union matters or how the Mariners lost another game, provided the conversation does not interfere with patient care or work duties and responsibilities.

Swedish further clarified that, in accordance with our contract, Union organizers may meet with employees only in public areas such as the cafeteria, but not in employee lounges. The Union put forth a proposal to allow Union organizers to meet with employees in lounge areas.

We all agreed that patient care is the primary focus while we are at work.

Questions or Comments?

Thank you for the emails and comments we have received. We appreciate hearing from you. Please feel free to submit questions or feedback to or here at

Hey Swedish! You missed the boat! Why on Earth would Swedish
decide to call in anyone to explain the importance of a "Wellness Program" when the members of the "Wellness Committee" were
sitting in the audience? I am quite sure that this committee could have
easily given the presentation (just as thoroughly) in one third the time
cost free and most employees would have been much more receptive hearing these important issues from respected coworkers such as those on the committee itself.

Human nature being as it is, there were a lot of insulted employees.
What a waste of our own resources. In my opinion Swedish needs
to start thinking in terms of employee value and put those values
into operation.It is a trust producing conduct that will increase the strength of our relationships.

"Aging, unhealthy workforce"? Perhaps a better choice of words
might have been "Wise,loyal and dedicated employees"
7/28/2011 11:16:52 PM
Swedish Bargaining Team
In response to the thoughtful feedback regarding this Negotiation News update, the information discussed by Dr. Axelrod was in no way meant to discount how deeply we respect the valuable and often life-saving work done everyday by our Swedish employees.

It is true that our workforce, like so many workforces around the country, reflects the changing needs of our nation’s 77 million baby boomers. And with age comes a greater need to care for our health and plan wisely for our future health needs.

As we all age, our health care costs will often continue to rise. We must plan ahead for how that impacts Swedish and do what we can do help our employees make preventative health care decisions and make the most of their existing health care plan.
7/25/2011 10:29:31 AM
daphne aberle
Dr. Axelrod,

My name is Daphne Aberle, I work part-time as an RN at Cherry Hill Family Medicine. I am also a massage therapist in private practice. I am disheartened by what seems to be a devaluation of the importance of complimentary medicine as care which is very often at least as effective as allopathic medicine in the treatment and prevention of disease, with a lesser side effect profile; and very often far more cost effective than allopathic interventions.

Just a few recent case examples from my own craniosacral therapy practice to illustrate my point:
1) A client saw me with a poor bite which was troubling her; her dentist wanted to break and reset her jaw. She saw me for 2 visits and her bite was corrected, and has now remained so for 6 months. What would have been the cost and risk profile should she have heeded the advice of her dentist?
2) A client came with incapacitating low back pain for 7 weeks. He went to a MD and PT, had xrays, etc; he was without relief. I saw him once. His pain was completely resolved within 48 hours after treatment, and he has remained without pain for the last 3 months. If he had been a Swedish employee how much would he have cost Swedish by way of diminished productivity?
3) A client came with a constant headache for 7 months. He saw his PCP, neurologist, PT, and had an MRI amongst other things. There was no understanding of etiology and no relief. I saw him twice; his headache is now gone.
4) A client with chronic migraines unresolved for over 15 years with a frequency of often one or more times a week. She now has migraines less than once every several months and with less severity. I saw her only 3 times.
5) …almost every client I see represents a story like these.

My cost per visit $90. By contrast, recently I came here to Swedish, for an evaluation and treatment with a PT after being in an auto accident and suffering whiplash. I was billed almost $400; it was beyond description the most useless waist of time and money. The above clients of mine spent hundreds, even thousands of dollars on traditional care without benefit. If they were Swedish employees they would have paid into our system which is great, but not as great as not needing to utilize the (ineffective in these instances) care in the first place.
I do receive my primary care here at Swedish. I do receive routine screening as recommended by my doctor. AND I do utilize complimentary medicine which is a huge part of my ultimately costing Swedish much less in insurance costs… THE TREATMENS ARE EFFECTIVE IN BOTH PREVENTION AND TREATMENT. There are many things that allopathic medicine is just not good at (such as treating pain without pharmaceuticals); these complimentary approaches meet the need when allopathic medicine cannot. Having access to naturopathy, chiropractic care, massage therapy, and acupuncture serves both employees, and what seems to be the bigger allegiance- your bottom line.

Daphne Aberle, RN, LMP
7/25/2011 9:34:17 AM
If you are a member if tge Swedish team, you are not valued, nor will you be valued. What I don't get is why Swedish feels the need to lie about how valued the staff (other than physicians) is.....why not just say, "we don't care, we don't have to" this is what you get, if you don't like it too bad. At least that would be honest but might look bad to the community.
7/25/2011 6:30:52 AM
Hetty Watters
As a nation, we are in financial crisis. Good for Swedish, opening a new, ergonomically 'green' facility and adding a good number of new jobs to the community!
Insurance and insurance premiums are out of control (and adding, in no small measure, to the spiriling costs of health insurance). Pete Stark (D-Calif.), chairman of the House Ways and Means Health Subcommittee, reported that the collective $9.3 billion in profits for the first nine months of 2010 of the top 10 insurance companies is up an average of 41 percent over the same period last year.
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We all must consider options to lower the cost of health insurance.
I differ with Dr Axelrod's conclusions. Accupuncture and massage is preventative. (New York TImes, Sept 20th, 2010). Mammograms and prostrate cancer screenings identify illness but do not prevent illness.
7/22/2011 10:08:44 PM
healthy employee
I have never been so insulted by an employer in my life - this email is an insult! I work more than my scheduled shifts at SMC to help my department, colleagues and patients and thats the thanks I / we get?!
We do a labor intensive job with a very high percentage of patients with BMIs over 35. In my department where lifting equipment and heavy patients is common place it is not surprising that staff have used their medical insurance from injuries!!!
When is the last time the managers have lifted anything heavier than a briefcase, Pushed stretchers that don't work correctly, used computers that are not ergometrically designed?
"Swedish cares"?? for who?
7/22/2011 6:11:48 PM
I thought we are tying to save money. How much did this consultation cost?
The most insulting kick in the teeth email I have ever received in my working llife.
7/22/2011 2:24:49 PM
Shelley B
My comment is brief. I listened to Dr. Axelrod's presentation on Tuesday and have to say alot of it is true. But Swedish really needs to rethink the proposal of raising healthcare premiums if they want us to participate and promote a wellness program to our coworkers.
7/22/2011 2:12:31 PM
Are you truely serious! Aging and unhealthy workforce, what an insult; if ever there was a time for our aging and unhealthy workforce to stand and unite behind SEIU it is now.
7/22/2011 9:39:09 AM
After doing some research on the items discussed in the issue of Negotiation News, I feel as though we as employees at Swedish deserve at the very least an independent review of our medical benefits and usage.

It seems to me that Dr. Axelrod and Dr. Hochman have very close ties from their past via Sentara Health. I feel certain that this was a biased review.

"Dr. Axelrod joined Anthem Blue Cross and Blue Shield’s Southeast region in March 2003 as vice president and general manager, Health Care Management. He was previously employed with Sentara Healthcare as executive medical director since April 1996."

"Rod Hochman, MD, is on the front lines of physician leadership as CMO for Sentara Health"

Also, this was the most insulting email (i.e. "In addition, Swedish’s unhealthy workforce is aging") I have ever received in my life. It did not make me feel valued as an individual or member of the Swedish team.
7/21/2011 8:54:46 PM
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