Executive Physical Exams and Managed Care

Although they may seem invincible, even top executives sometimes become seriously ill. Realistically, some of these illnesses are unavoidable. Although executive physical examinations cannot prevent serious disease, a well designed and well-utilized executive exam program can detect serious illness at earlier and more treatable stages.

Nearly half of larger U.S. employers currently offer executive exam programs, according to a recent Arthur Andersen, Financial Executives Institute study. Forty eight percent of companies surveyed offer executive physicals as one their top ten executive perks – ranking second just behind cell phones (66%) and ahead of company cars (44%).

Despite its continued prevalence, new executive examination programs are not at the top of the priority list for many corporations today. It is a benefit that is alive and well, expected by many senior executives, yet rarely introduced as a new benefit. And, when they are proposed, coordinating periodic executive physicals in the managed care environment raises so many issues that the programs are often tabled.

One point to consider is that executive physical examinations may give corporate executives a better understanding of your company’s managed care plans. Unfortunately, executives are the employee group least likely to use managed care appropriately. But, they are often your first line of communication with employees about the company’s benefits plans and managed care choices. Getting senior executives to buy into your managed care plans through an executive physical exam program may be a key element to containing escalating health care costs. Coordinating executive physicals through an existing benefits plan is a simple way to promote the plan. Working with preferred providers from your managed care plan, an executive exam program can be easy to administer and cost effective.

One word of caution – just because your plan has a prevention or wellness component doesn’t mean that it can directly translate to an effective executive exam program. Managed care organizations’ marketing personnel will readily agree to assist, but realistically don’t have the mechanisms in place to effectively manage an executive physical program. Locating and utilizing program management resources outside of the managed care organizations is essential.

There are several models in use for these new hybrid executive exam programs–programs that effectively utilize managed care providers for executive physicals or periodic exams. For example, Corporate Wellness, Inc. developed a program for a major reinsurance company where all company officers are sent birthday cards advising them: “It is time for your physical.”

When executives call or email Corporate Wellness to schedule their examinations, each is given the option of seeing a managed care primary care provider selected previously, selecting one now, utilizing a traditional executive physical exam clinic or seeing a personal physician of choice (nonnetwork provider).

For this program, Corporate Wellness schedules the exam and handles all of the details related to payment and billing. A single executive physical exam may result in up to ten separate payer invoices when an out of network provider is used. Sometimes, the plan only covers some of the recommended components and the executive physical program picks up the difference for additional components or higher fees.

Executives are encouraged to see primary care providers, especially if the provider was selected from a provider directory at enrollment and the executive has not yet seen that doctor. The first interaction with that doctor should never be at an emergency room in the middle of the night.

Since the exam is often covered by the managed care plan, the direct program costs may include only the copay. If the executive selects another executive exam provider, he or she is encouraged to have Corporate Wellness arrange for reports to be sent to the primary care provider to be added to the provider’s medical record for the executive.

Another model includes similar reminders for periodic examinations, but this time, for all employees, following the guidelines for coverage in the managed care plan. All employees, not just executives, senior management or the highly compensated, are prompted to schedule periodic exams with primary care providers. This model directly addresses criticism that senior management is no more important to an organization than the people who handle customer service calls, communicate with clients, provide services or keep everyone on payroll.

A typical examination would include a medical history, basic audio and vision screening, blood pressure screening, pulmonary function test, electrocardiogram, handson physician physical (by an M.D.), and basic laboratory studies (complete blood count and full blood chemistry including a lipid profile). Chest –x-rays may be included periodically, especially for smokers. Prostate cancer screening using the PSA laboratory test may be included for males over the age of forty. Mammograms are generally included for female executives age 35 and older following the American Cancer Society guidelines (a baseline at age 35, biannual mammograms from 40 through 49 and annual mammograms age 50 and over).

Many executive physical programs also include a proctosigmoidoscopy for executives over age 40, with agedriven frequency.

It is paramount that executive exam programs and periodic exam programs include components that are appropriate for your specific employee population. For example, if your executives are all under fifty, including either prostate cancer screenings or colorectal cancer screenings is going to be less meaningful and utilized less frequently. Body fat content might be a better choice. Cholesterol profiles will be important to everyone.

Setting minimum exam components and maximum exam reimbursements works for many organizations. Consulting with your managed care plan SPD should be a starting point.

Executives who effectively utilize managed care personally are far more likely to promote effective use of managed care throughout your organization. When a senior manager is speaking about her personal experiences, employees are more likely to be more receptive. An executive physical exam program may be an inexpensive and simple means toward achieving this goal.

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Roslyn Stone, MPH is C.O.O> and Principal of Corporate Wellness, Inc.

Corporate Wellness, Inc. (www.corporatewellness.com) is based in Mount Kisco, New York, and coordinates employee health services nationally. Ms. Stone can be reached at 1-800-433-9594 or rstone@corporatewellness.c