Self-Insured Schools of California: Less Medical Spend, More Classroom Dollars
June 22nd, 2020  by  Nicole Henry – Health Benefits Coordinator
at Self-Insured Schools of California (SISC)

For Self-Insured Schools of California (SISC), a community of 400+ California public schools, saving on healthcare spend for our members translates into more public dollars for investing in the classroom and our children’s education. By pooling our resources, we can provide schools with a more stable, long-term insurance solution rather than purchasing health insurance from commercial carriers.

Address MSK spend to ensure dollars stay in the classroom

To ensure public dollars stay in the classroom, SISC set out to address high medical spend on musculoskeletal (MSK) conditions, our number #2 cost driver. I recently spoke on a webinar hosted by The Conference Board together with Dr. Jeff Krauss, M.D., Chief Medical Officer at Hinge Health. In this recap blog, I summarize how SISC partnered with Hinge Health, a digital MSK solution, to reduce our high MSK spend and enhance the physical and mental health of our members.

With MSK surgery as one of the main drivers behind our high medical spend, we wanted to find alternative options for our members to reduce their chronic back and joint pain more effectively. Due to COVID-19, members had also delayed MSK surgeries and we were aware of potential pent-up demand for surgery next year. Offering alternative digital solutions to treat chronic back and joint pain at home is important now more than ever.

Many members suffering from chronic MSK pain often view surgery as the only option and they aren’t aware other solutions could offer better outcomes. For example, Anne, a 64-year old accounting clerk at a SISC school district, suffered from constant knee pain. After Hinge Health’s digital MSK program, her pain was reduced by a third and she realized she didn’t need surgery after all. “I assumed that a knee replacement was inevitable. I was even ready to schedule it except I couldn't afford to take that much time off. I am so happy to realize that I can avoid it, or at least postpone for a long time,” shared Anne.

Physical and mental health is crucial for our schools

SISC is committed to enhancing our members’ well-being, and addressing MSK care is a priority for us. The physical and mental health of our members is crucial to providing the best education for California’s students. With an average age of 50+, back and joint pain are prevalent among our population across a variety of jobs--whether its teachers on their feet all day, bus drivers maneuvering heavy vehicles, or office workers on computers all day.

Before COVID-19, our members with chronic back and joint pain struggled to find time for physical therapy visits. For example, teachers are expected to be in the classroom every day and missing work involves finding a substitute teacher. Now with COVID-19, in-person physical therapy is not even an option. For these reasons, we were interested in exploring a digital MSK solution. We realized solving access to care and physical therapy is half the battle in helping members resolve their back and joint pain.

What we were looking for in a digital MSK solution

  • Promotion & high engagement: Since SISC is a consortium of schools and we’re not the actual employer, our main challenge is ensuring members are aware of new healthcare benefits. We can’t hold mandatory meetings or communicate as easily with members. As a result, we wanted a partner who would help roll out the digital MSK solution, so the program could launch without a hitch. This involved helping us promote initial enrollment as well as sustain long-term engagement.
  • Proven results: When looking for a solution, we placed emphasis on reviewing vendors who could demonstrate proven results--both in terms of reduced medical spend and better health outcomes for our employees. Since chronic MSK pain and mental health are closely related, we wanted to see quality of life improvements in both chronic MSK pain and mental health.
  • ROI guarantee: We expected some form of ROI guarantee which also demonstrates the partner is committed to our members’ health. If people aren’t engaging in the program, then it has little value to us.

Coaching is at the heart of the Hinge Health program

Based on meeting our above priorities, in 2020, we partnered with Hinge Health’s sensor-guided exercise therapy paired with remote 1-on-1 coaching and interactive education. Hinge Health rolled out all the promotion efforts for us to drive enrollments, including postcards, social media ads, and emails via school districts. Hinge Health’s marketing activities went beyond what other vendors offered and we appreciated their creativity in trying different approaches to reach high enrollment numbers.

When we first implemented Hinge Health, we didn’t realize the impact of the coaching element of the program. But now we are witnessing tangible results, we recognize 1-on-1 coaching is at the heart of Hinge Health’s success. Hinge Health’s health coaches play an important role in educating participants and keeping them accountable.

SISC participants on average talked to their health coach around 5 times a week. I don’t even talk to my mother that much! As I mentioned earlier, SISC is one step removed from our members. We rarely communicate with them directly, since their actual employer is the school district.

However, the Hinge Health coaches were able to talk directly with SISC participants. They were in tune with SISC participants’ day-to-day circumstances and could offer motivational reminders to keep them doing their prescribed exercise therapies. We’ve heard feedback from users that the coaches are the main reason they stuck with it and engaged in the Hinge Health program. The Hinge Health coaches also took a step further. Since the coaches are aware of all our other healthcare resources, they were able to offer integrated advice and referrals for related healthcare issues as well.

Hinge Health outcomes: Positive impact on our members and our schools

Because of the health coaches’ support and motivation, 3500+ SISC participants enrolled in the Hinge Health program and enjoyed the following results (May 2020):

  • 54% chronic MSK pain reduction on average per participant--which is 3.5x better than relying on opioids for pain reduction.
  • Dramatic improvements in mental health with a 94% decrease in anxiety and a 91% decrease in depression by participants on average. Chronic MSK pain and mental health are closely related, and improving anxiety and depression in teachers is critical for them to do their jobs effectively.
  • 31% decrease in absenteeism and presenteeism--keeping teachers and staff in the classroom.

We are pleased with the results of the Hinge Health program. Not only did we avoid MSK surgeries and cut medical spend, the improved physical and mental health of our teachers and staff had a positive impact on our schools and the quality of our children’s education.

To learn more about how to reduce medical spend while prioritizing staff and employee wellbeing, request a demo below.

About the Author

Nicole Henry is the Health Benefits Coordinator at Self-Insured Schools of California (SISC) where, under the oversight of the DEO, she is responsible for the daily operations of the health benefits department that provides service to over 400 school districts and 350,000 members. Nicole started her career at SISC in 2007 where she worked as an eligibility technician, an underwriter/data analyst, and an account manager. Nicole received her bachelor’s degree in human services from the University of Phoenix and is a graduate student at West Texas A&M University where she is earning an MBA in Healthcare Management.

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