HEALTH INSURANCE
Health insurers pushing wellness programs
Emphasize fitness, nutrition and prevention
Western New York’s three big health insurers are offering more wellness and disease-management programs as a means to lower health care expenses and keep premiums under control.
The goal is to keep employees healthy and to help them manage chronic conditions that are among the biggest contributors to medical expenses. By keeping employees physically fit, eating right, and avoiding risky behaviors like smoking, insurers hope to avoid the costly medical care that drives up premiums.
“An ounce of prevention is worth a pound of cure,” said Dr. Robert Holzhauer, vice president and chief medical officer at Univera Healthcare. “Sometimes people just get sick, but there are things that people can do. Many of the illnesses can be prevented if people start early.”
Insurers and employers are using a mixture of incentives and penalties to encourage employees and their families to evaluate their own health, obtain information that will educate them about their risks and conditions, and make better choices in everyday activities.
“Our goal, in part, is to engage our members in their own health and well-being,” said Tom Haney, wellness administrator at Independent Health.
It’s become such a popular topic that the insurers no longer have to convince employers to promote wellness. The employers are now asking insurers in advance to develop work site programs as part of their contract proposals, even selecting insurers based on what the carriers offer for wellness.
“It’s less promotion on our part these days, because employers are looking for ways to control costs,” said Cheryl Howe, executive vice president of operations, health services and marketing management at Buffalo’s HealthNow New York, parent of BlueCross BlueShield of Western New York. “Managing illness is too late. Preventing illness is where the money is.”
“I’ve seen more and more employers saying we’ve got to do something,” said Mary Ann Sansone, account executive at First Niagara Benefits Consulting. “The carriers are really stepping up proactively to do things, because they know if they don’t do it, somebody else is ready, willing, and able to.”
The shift in attitude by insurers and employers in recent years comes as health insurance premiums continue to skyrocket, making it increasingly unaffordable for many employers to offer to workers. Working with insurers, companies have been raising premiums, co-pays and deductibles, and cutting or restricting benefits, but they’re running out of options with little sign of serious relief.
“We can’t just keep pushing more of the cost on employees and hoping that’s suddenly going to change their lifestyle,” said Univera regional vice president of sales Pamela J. Pawenski. “If you’re going to be paying for more costs of services, you may be more inclined to be savvy consumers. It’s their money, so maybe they’ll be a more judicious user of those resources.”
According to the Employment Policy Foundation, private employer spending on employee health benefits has risen 51.4 percent. Employers spend an average of $8,000 a year per worker, which could rise to about $14,000 within five years.
That’s where wellness comes in. Studies show 70 percent of health care costs are tied to the treatment of chronic diseases like heart disease, lung disease, stroke, diabetes and cancer.
Indeed, heart disease, cancer and stroke are the three leading causes of death in Western and upstate New York. Diabetes is No. 5 locally, and also contributes to the other diseases.
But doctors and insurers say these are diseases that can be either prevented entirely or managed to avoid more severe health problems. So the root of these conditions is often personal lifestyle choices such as smoking, eating too much or of the wrong foods, not exercising or not keeping up with drug regimens. Indeed, such choice and responsibility is also the concept behind the push for health savings accounts and high-deductible health plans.
“It’s extremely important to push wellness and to push personal responsibility,” Holzhauer said. “People throughout Western New York are eating too much, eating the wrong things and not doing enough to keep themselves healthy.”
Studies show that wellness efforts pay off. A study by the Department of Health and Human Services found employers cut health expenses by 20 percent to 55 percent, reduced short-term sick leave by 32 percent and boosted productivity by up to 52 percent with wellness.
And a November 2004 report by the Center for Prevention and Health Services said employers recover $3.48 in reduced health care costs and $5.82 in lower absenteeism expenses for every $1 they invest in wellness.
“There’s a lot of employer demand. They see the benefit,” said Dr. Jay Pomerantz, Health- Now’s chief medical officer.
But employees don’t always cooperate. So insurers are rewarding them to buy participation. A national survey of 450 employers by Hewitt Associates found almost half offered incentives such as gift cards, discounts, cash, credits or prizes, up from 38 percent a year earlier.
HealthNow
The concept of wellness is broad. Many insurers and companies are introducing programs for employee exercise and fitness, smoking cessation, nutrition and diet, blood pressure management, stress management and cholesterol management. Such efforts also include workplace gyms, on-site health fairs, health screenings and work site health clinics.
Locally, HealthNow has already been active with wellness efforts, such as through its Alive and Lively program, but they were not always targeted to a specific company’s needs.
This month, however, it introduced its Blue Life online feature. That’s centered around an integrated Web site through a national company called HealthWays, where the insurer can collect and track health data using health risk assessments filled out by employees.
The insurer can then use the confidential data to identify what general health areas each employer should focus on. It can also provide summary reports on what wellness initiatives are working or might need incentives to boost participation, but only at employers with at least 50 workers, so that individuals cannot be identified.
And the rewards can be uniquely designed, such as giving out iTunes for one employer with a lot of young workers.
Through HealthWays, the insurer can also offer health coaches by telephone or online.
The insurer also offers the national BlueCross BlueShield Walking Works program, giving out pedometers to members to track their steps as a way of encouraging exercise. According to Pomerantz, 15,000 steps a day — about 3 miles — improves overall physical health. The American Heart Association recommends 10,000 steps.
Employers sponsor “walk at work” days or regular daily walking periods, or encourage use of stairs. One local radio station client, the City of Buffalo and the Seneca Nation even hosted internal competitions between its floors to see who lost more weight taking the stairs. And truck drivers might be urged to climb up and down the cab 25 to 30 times, or walk the length of their trucks.
“Just that little bit every day really does make a difference,” Pomerantz said. “It isn’t that tough to do.”
HealthNow tests many of its ideas on its own workplace and employees first. For example, the insurer’s in-house “Healthy Solution” program combines a fitness center, healthy dining choices at the cafeteria, healthy options in vending machines and rewards such as discounts for eating healthy foods.
Independent Health
Independent Health also has been trying for several years to bring different programs, tools and ideas to the marketplace, tailoring programs and now incentives to individual groups.
The company introduced $0 co-pays for all preventive services, as a means of encouraging people to take care of themselves and prevent problems from ever occurring. And it’s tweaking other benefit designs.
“We want to eliminate barriers for people to make the right decisions to seek the kind of care that we know is going to make a difference,” said CEO Dr. Michael Cropp. “People who are doing the right things to stay healthy will need to spend less out of their own pocket.”
The insurer has a full-time staff of health educators that work with specific companies to assess their needs and design plans to meet them, as well as registered nurses who act as health coaches with members.
It also rolled out information tools so members can track progress and be educated.
For incentives, the company has deliberately shied away from penalties, preferring to encourage good behavior rather than punishing for things that may not even be in someone’s control. “We’re not a believer in penalties,” Cropp said.
And like HealthNow, it tests its initiatives with its 1,000 employees. “We want to make sure it’s practical and it works, and there’s no better place to test it than right here,” Cropp said.
For example, Independent Health introduced a “walk station,” where employees can get on a treadmill at a “casual pace” but still have a computer and phone. The company also has bicycles available on its Williamsville campus. And it will offer a “wellness day off” for employees’ personal needs.
Also, the company’s inhouse HealthyMe wellness program gives points for choices, such as wearing a seat belt or taking a daily vitamin. When employees reach a minimum number, they become eligible to win $250.
“In the past, wellness was glossed over a little bit as being fluff. You’d have someone coming in and giving a lecture on stress management and think people were going to change,” Haney said. “Now, we know we have to incentivize people.”
Univera
Univera has an array of wellness programs for both its members and the broader community, such as Active Univera, Fit 4 Life, Fun 2B Fit, 2Smart2Start and Take Steps.
“Employers are consistently trying to find ways to drive down their cost trends and are very interested in what kinds of services carriers like us can bring,” Pawenski said.
For example, Fit 4 Life is the company’s quit-smoking program for all members, while Take Steps encourages everyone to make better food choices and increase fitness by following fitness guidelines, using suggested recipes and tracking physical activity.
Fun 2B Fit and 2Smart2Start are aimed at children. The first is a school-based healthy lifestyle program encouraging children in second through fourth grades to develop good eating habits and be more physically active. The second is a smoking-prevention initiative for third through fifth grades that includes rewards and a discount card for merchants. About 123,000 students have participated.
And Active Univera gives credits of up to $500 for individuals or $1,000 for a couple by tracking their daily diet and exercise, and rewarding them for good decisions like eating nutritional foods, getting health screenings and quitting smoking. Members earned $750,000 through the first nine months of last year, and officials believe the program will be the company’s arena for growth this year.
Like Independent Health, the company also offers no copays for many preventive services.
“We’re willing to bribe them to do the things that most people know we should be doing anyway,” Pawenski said.
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