The more you treat, the more money you save - part four of eight

Company executives should be good at strategy, but the way most firms manage HIV/AIDS in the workforce shows there are some things they don't understand. They allow profiteering schemes to undermine HIV/AIDS treatment.

Two weeks ago Business Report explored current thinking on the economic viability of employers sponsoring the treatment of HIV/AIDS in the workforce. A key success factor in this viability is volume.

A sick, unproductive employee costs the company more than the price of treatment. By sponsoring treatment, the company saves money.

If offering treatment to one HIV-positive employee is a saving, offering it to more is a greater saving, reducing the average cost of any education and testing infrastructure required. This argument holds irrespective of who pays for treatment and whether or not the employee is on medical aid.

Most companies are happy to find they have few patients on their programme. Some feel they have delivered on employee and shareholder expectations at minimal cost, and others feel it is a reflection of low prevalence.

But HIV/AIDS intervention is not a public relations exercise. Employers should be treating HIV-positive employees because it saves the company money.

And once they have made the decision to offer treatment, they have a responsibility to deliver. Low uptake simply means programme failure; wasted money, wasted time - and wasted lives.

Forward-thinking employers are now recognising that the antiretroviral therapy uptake rates on medical aid and HIV/AIDS management programmes are completely unacceptable (under 1.5 percent, according to a recent Markinor survey).

These programmes do nothing to address company costs, and it's time for employers to take matters into their own hands. Testing uptake rates at DaimlerChrysler and BMW have exceeded 50 percent, showing what can be achieved by people who want to see treatment work.

The first obstacle to high patient uptake is voluntary testing. It must be easy for the employee to access, costs must be covered and confidentiality must be maintained.

Medical aids achieve absolutely none of this and do not even cover the cost of testing. Why would a medical aid facilitate the process when any patients identified are an additional cost?

The solution lies in using a service provider that has relationships with laboratories throughout the country. Employees should be able to go to any lab, even one far from home. They should not have to pay or claim any bills, and the results should be sent to an independent party so that the company can't even find out who has had a test.

This way, legal barriers are surmounted and the employee's best interests are maintained.

The second barrier to patient volume is programme uptake.

In most of the leading programmes we have audited, less than 30 percent of the ill patients who should have been on therapy actually were.

Once again, we find that the paying party is rarely the company and that its interests are contrary to those of the company.

HIV specialists frequently lament the difficulty of accessing medical aid and insurance benefits. The bluest of the blue chip schemes are the toughest to access, and even executives are finding they have to jump through hoops and over hurdles before their claims are paid.

Medical aids will pay for treatment only once an employee's CD4 count (a measure of immune system degradation) is below a certain level, and even then only if the employee has also shown certain opportunistic infections.

This level is simply too low when one is focused on productivity management. A well-managed patient should not get to these levels for many years.

So who carries the bill in the interim, given that it is not in the employer's interests to let an employee reach this level of illness before starting treatment, as this simply doubles the cost of HIV on the business (productivity loss plus treatment cost)?

There is a way around the conflicting interests of HIV/AIDS management. First, an employer should pay for the employee's treatment and then deal with the medical aid or insurance fund to recoup whatever costs can be recouped. Even if these costs are not recouped, the employer has still driven an economically viable programme.

Employers should not allow those with conflicting interests to manage their firms' wellbeing.

Second, this programme should be outsourced so that tests and treatment are confidential.

There are several HIV/AIDS management companies such as LifeWorks and Direct Aids Intervention, that are independent of medical aids. They offer to manage HIV on behalf of the company, which pays the manager for costs incurred by anonymous patients.

Auditing mechanisms check for "ghost" patients. Medical aids are incorporated through a back-office claims process, ensuring that benefits that have been paid for are indeed used, and providing a consistent programme for both insured and uninsured staff.

The process overcomes the conflicting interests that are bringing HIV/AIDS management programmes to their knees.