Health plans add financial motivation to wellness programs

These new programs reward members, but experts say doctors might benefit as their payments become based more on quality and patient engagement.

By — Posted Feb. 20, 2013

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As the insurance industry continues to expand wellness programs, it is taking on caregiving roles that health plans believe are meant to complement and not compete with doctors’ efforts.

“As a health plan, we don’t want to insert ourselves in the middle of the doctor-patient relationship,” said Cigna spokesman Joe Mondy. “Instead, our role is to support both the doctor and patient with the great health care challenge of the 21st century — helping individuals change unhealthy behaviors and make health a fun and interesting part of everyday life.”

Cigna recently developed a wellness infographic website that helps members understand what health system reform means to them with a personalized survey. The survey asks members for general demographic and insurance information before telling them how heath reform will affect them specifically.

Consultants say they understand doctors’ skepticism, given ongoing battles over coverage, about health plans’ sincerity in not inserting themselves between physicians and their patients. But in this case, they said, the insurers’ efforts to reduce their expenses by encouraging wellness could end up helping doctors as payment shifts away from straight fee-for-service and more toward value-based care.

Although most plans offer members small premium discounts if they report healthy behaviors, insurers are beginning to offer more programs and financial incentives so people make such activity a habit.

For instance, UnitedHealthcare offers a program called Personal Rewards that allows members to make up to $600 per year, or $1,200 per couple, for meeting nationally recommended health benchmarks for cholesterol, blood pressure and body mass index. Patients who achieve these levels sign up with telephonic health coaches to earn money when they complete the coaching.

Humana offers Vitality Bucks, which members earn when they become active, lose weight and eat healthy. The money can be redeemed for movie tickets, events, merchandise and hotel stays.

Fitness incentives, too

Some insurance companies offer fitness incentives through gym memberships or reimbursements for fitness activities. Many Blue Cross Blue Shield-affiliated plans offer Blue365, a program in which members get a $25-per-month rate for national fitness centers, including Snap Fitness, Curves, Gold’s Gym, Anytime Fitness and YMCA.

One of the newer wellness efforts is Aetna’s fitness reimbursement program, which was announced in November 2012. The program reimburses members for a wide range of fitness activities, including gym membership fees and group exercise, personal training, fitness equipment purchases, and weight management and nutrition counseling.

As an example of plans trying to incorporate “fun,” as Cigna’s Mondy put it, UnitedHealthcare partnered with Konami Corp. in December 2012 to bring its popular Dance Dance Revolution game into classrooms in an effort to combat childhood obesity. The game requires players to move to match steps with what they see on-screen.

Industry consultants said that although doctors don’t need to know about all wellness plans offered by insurers, it would be a good idea to understand general trends.

“We are changing the way physicians are paid based on the [health] status of the population,” said John Keith, practice leader in value-based care services at Deloitte Consulting. “By using these tools, doctors can improve that status and will be rewarded for that.”

Keith said insurance-based wellness programs are most effective when doctors promote them, because patients place a great deal of trust in their opinions. Also, the most effective wellness programs are easily incorporated into patients’ lives, he said.

“It becomes part of the patients’ lifestyles, so they are almost invisible to them. They engage patients in clever ways. Those are the ones that are taking off,” he said.

The next big wellness trend in the insurance industry probably will be rewarding patients for buying certain types of food, said Michael Trilli, senior health insurance and payment analyst at Aite Group, a research and advisory firm focused on business, technology and regulatory issues. As with reimbursements for gym memberships, patients may be reimbursed for buying fruits and vegetables at grocery stores.

“This is the next big wave,” Trilli said. “This is the area to watch.”

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