It is a Matter of Time Before Every Health Plan Has a Rewards Program

Rewards for healthy behaviors have been growing at leaps and bounds as a way to reduce healthcare costs for several years. In 2009, employers offered employees $260 in rewards for making healthy choices. Now, companies are projecting to spend $693 per employee on wellness incentives. ObamaCare added fuel to the fire. It increased the allowable amount of rewards from 20 percent to 30 percent (and in the case of smoking cessation) 50 percent of annual premium. Forbes named “health rewards” as two of the top 5 health IT trends in 2014.“Incentive Driven Healthcare” is here to stay.

Why don’t health plans want consumers to know this? It seems like a win-win. Well in some ways they do. Health plans win by reducing costly behavior through prevention and lifestyle changes. Consumers benefit not only by getting healthier and making better health decisions, but by receiving rewards. This is all true. But in some ways they don’t. Once consumers realize that purchasing health insurance, while incredibly personal, is nothing more than purchasing another consumer product, the marketers of the world will be faced with a health rewards competition.

ObamaCare created “exchanges” or “marketplaces” through which health insurers compete for the business of individuals and businesses. These marketplaces were established with a series of pre-packaged health plan options, which limit the variations in using traditional levers such as coverage and networks. Health plans that were used to competing on these levers are left with a single lever – price. Selecting from gold, silver and bronze hardly creates differentiation among UnitedHealthcare, Cigna, Aetna, Humana, Wellpoint, the Blues and many other plans in the United States.

Think of your credit card, hotel, airline or favorite retailer. It is a sure fire way to create loyalty, brand affinity and engagement. Let’s be honest, you are more inclined to use specific services or retailers if they provide a robust rewards program. When marketers of consumer products ask themselves “what tools do I need to attract, retain, and generate loyal customers?” the answer inevitably comes to reward programs.

As further evidence, consumers across multiple demographics were interviewed on what they wanted from their health plan. The only item that appeared in every demographic was “rewards for healthy behavior.” Would you have a more positive opinion of your health plan if they sponsored a program that rewards consumers for healthy behaviors? According to a Welltok survey, 75  percent of respondents agree. Furthermore, 81 percent said that access to such a program positively influences their decision to renew with their current plan. Not to mention, the fact that incentives are a proven means to motivate health choices and change behaviors. More than 96 percent of consumers would engage in healthier behaviors if rewarded.

Health plans are entering a new competitive landscape. Rewards will not only be an essential component, but will also drive a healthier population – creating a win-win situation for all.


Dermer

Michael Dermer is the Chief Incentive Officer of Welltok. Prior to his current role, Michael was the founder and CEO of IncentOne, the first company that in 2003 identified incentives in healthcare as a critical solution to driving consumer and provider engagement.  Michael is considered one of the nation’s experts on rewards and incentives in healthcare –learned in running over 4,000 programs and 40 million transactions over ten years. His personal mission is a national reward program in which all Americans can “be healthy and be rewarded.” Since 2003, he has been guiding health plans, employers, health systems, governments and providers in how to use incentives to deliver cost reductions and health improvement.

Twitter: @rewardforhealth

Linked In: https://www.linkedin.com/in/michaeldermer

Advertisements

What Employers Want from ACOs for Better Population Health

When employers think about population health, they are thinking about the health of their workforce and their retirees. Employers want their workforce and their retirees to become and remain healthy. For large, self-funded employers this is about the bottom line and reducing health care costs, but more important than that, it’s about employee/retiree health outcomes, satisfaction and employee productivity.

Accountable Care Organizations (ACOs) are one of the promising new models of health care delivery that seeks to deliver better quality care at lower costs. ACOs can be designed to improve the quality of care, increase patient satisfaction, and lower the cost of care by aligning incentives and connecting the care provided by hospitals, medical groups, and health plans to work together to decrease fragmented care. So what are large employers looking for from ACOs?

First and foremost, employers want an ACO to consider the care of “the whole person.” They recognize that not all ACOs are alike and that they have different capabilities.  They expect ACOs to meet all the care needs of their employees, including behavioral health. To do this, the ACO needs a wide variety of service providers that deliver a holistic menu of care. For example, if the patient has a psycho-social issue, the ACO should have a social worker who can address that issue. If the patient needs to lose weight to help with her diabetes, she should have access to a dietician to work on changing her eating habits.

Second, employers want their ACOs to offer integrated care. Fragmented care is not only challenging for patients to navigate– it is not clinically optimal.  Primary care providers, behavioral health providers, pharmacy staff and specialists should work together, share information with each other, and have shared incentives for the same goal: the patient’s best interest.

Employers also want their ACOs to be able to identify the highest-risk patients and target them for special intervention. The greatest savings come from identifying the sickest patients and keeping them out of the hospital. The ACO needs to be able to identify these individuals and intervene before episodes escalate out of control. Some early employers in this space have seen great success with this targeted intervention, which is now a vital component of both employer-driven and health plan-driven ACO products.

ACOs also need to be able to support“smart” benefit design features designed by employers to engage employees in a partnership for value based healthcare.  This means ACOs should have programs and policies in place that align with the employer’s goals of promoting patients’ access high quality care, and  efficient use of care.  Appropriate utilization of high priced procedures, integration of step therapies, and shared decision-making have been shown to reduce cost and improve outcomes.

Finally, employers want their ACOs to embody quality improvement and payment reform. For decades, employers have been concerned about the variance inquality of care of our health care system. They know they spend too much for care that is too often unneeded, unsafe, and of poor quality. ACOs should be committed to quality improvement, and capture data so they can track their quality outcomes including patient reported outcomes. They should work with their partners implement new forms of payment that rewards for good quality, and that does not pay for waste and efficiency.

Vela headshot

Lauren Vela, MBA

Senior Director of Member Value, Pacific Business Group on Health

As Senior Director of Member Value, Lauren works directly with the large purchaser members of PBGH to facilitate collaboration and to support their purchaser-driven initiatives impacting healthcare delivery in the US. To that end, Lauren manages the processes of translating PBGH’s ground-breaking work in transparency and accountability into workable solutions for PBGH member organizations.

Prior to this role, Lauren was the Executive Director of the Silicon Valley Employers Forum (SVEF), a coalition of high tech employers that benchmark benefit designs and collaborate for improvement. During her SVEF tenure, Lauren systematized the group’s benchmarking practices and served as a facilitator and strategist for their joint projects with regard to both US-based and international employee benefit programs.

Prior to the SVEF role, Lauren enjoyed a twelve-year tenure with PBGH serving in three distinct areas; multi-stakeholder health information exchange, provider group organization improvement, and employer value-based purchasing. To this day, SVEF and PBGH maintain a strategic alliance and Ms. Vela works closely with purchaser members of both groups.

 

A New Alphabet Soup of Payment Models, Medicare Programs Drives Providers to Focus on Population Health

For providers, changes in payment models are now driving a much stronger emphasis on population health. Under the traditional fee-for-service model, providers don’t have a financial incentive to think about the health of a given population or community; they are simply paid for every test or procedure performed on each individual. But under new payment models such as accountable care organizations (ACOs) with shared savings, providers’ ability to improve the health of a population is directly tied to financial reward—and, in cases when they fail, a financial penalty. Some new payment models also help pay for care coordination and other much-needed services.

All of this recent change is being driven by the 800-pound gorilla in healthcare, Medicare. The Medicare program has put a huge new emphasis on value-based payment models. In January of this year, Health & Human Services Secretary Sylvia Burwell announced that by 2018, 50 percent of traditional Medicare payments will be tied to quality or value, via alternative payment models like ACOs and bundled payment arrangements.

The Medicare Access and CHIP Reauthorization Act (MACRA) recently passed by Congress makes dramatic changes in how Medicare pays providers. By 2019,Medicare providers must choose between participating in an alternative payment mechanism (APM) or in the Merit-Based Incentive Payment System (MIPS). Providers who receive a significant percentage of their income through APMs can opt out of MIPS and receive annual bonus payments of 5 percent. Those who participate in MIPS will be scored based on quality measures, with their scores reported publicly. High-scoring providers will earn financial rewards, while low-scoring providers will be subject to payment reductions. Given a choice between these two paths, there is an enormous incentive to move to APMs to avoid being publicly “graded” and possibly penalized.

As Medicare goes, so goes the rest of the healthcare system, and we are seeing a dramatic shift toward more value-based payment in the commercial sector as well. As much as 40 percent of payments to providers from commercial health plans are now tied to value, according to Catalyst for Payment Reform’s 2014 Scorecard on Commercial Payment Reform. Across the board, most providers understand the new payment models have the potential to help them deliver better care by actually paying for care coordination. And many recognize that better population health management can lead to greater income as well. Still, some providers are concerned about how all of this will affect their autonomy. However, the alternative—greater cuts in the Medicare fee schedule—is even less palatable.

Already, we have seen some provider groups embracing change; there are impressive pockets of excellence across the country. My home state, California, is no stranger to new payment models—capitation was born here. But our organization has expanded focus beyond California, and we have many members in other states doing groundbreaking work. For example, New West Physicians in Colorado has done a remarkable job improving population health with their ACOs and special attention to chronic care management in the Medicare population.

As we continue to change how providers are paid, I am optimistic we will have a triple win—for patients, providers and policymakers alike. Even in a healthcare system traditionally plagued by unsafe care, waste and inefficiency, the right payment models can lead to better population health, along with financial gains for providers and higher-value care all around.

Don2012-small

Don Crane is President and CEO of CAPG, the nation’s only professional association that exclusively represents capitated, coordinated care organizations, and is a leading voice promoting the interests of physicians practicing accountable care across the nation. CAPG consists of over 190 multispecialty medical groups and IPAs that provide medical care to over 16 million patients across 39 states, the District of Columbia, and Puerto Rico.

 Mr. Crane is in the forefront of California and national public policy advocacy on behalf of accountable care organizations across the country as they make the journey from volume to value and move into risk based alternative payment models.  

Guest Post: Sun Health’s Community Health Focus Promotes Patient Engagement, Healthy Living

JDrago headshot 2-2013Jennifer Drago, FACHE, MHSA, MBA, Vice President of Business Development, Sun Health

What do you envision or expect will be the most significant opportunities for the population health management industry in 2014?
I believe that the biggest opportunity our industry has is in educating health care consumers about the role they play in maintaining and improving their own health, especially when living with one or more chronic illnesses. If providers and payers alike are able to provide opportunities and reduce barriers for consumers to undertake behavioral modifications to improve their health and well-being, we may encourage positive change that not only benefits the consumer, but also decreases financial and resource strains on the entire health care system.

At Sun Health, we’ve focused on providing education and self-management support that assists community members in having a successful recovery. Through our Care Transitions program, nurses visit patients in the hospital, again when they are home and follow up with phone calls during the post-discharge period. Care Transitions nurses educate and monitor adherence to medication schedules, share information about what signs and symptoms to watch for following a major chronic disease procedure or hospital stay, and connect participants to community resources such as transportation and home-delivered meals. The ongoing support and guidance encourages patients to take ownership for their health, and has reduced readmissions for the target population by more than 60%. Next, we are launching a Center for Health & Wellbeing where those with chronic disease can benefit from personalized health assessments, action plans designed by dietitians and exercise physiologists, and assistance in making lifestyle modifications when needed.

What will make 2013 a successful year for our industry in policy, research, and technology?
Identifying triggers that negatively impact health and collaborating to address these issues. In the retirement areas that Sun Health serves, for instance, we’ve learned that a lack of transportation options is a major reason why some seniors can’t access health care services, stay connected via social engagements and even shop for groceries. Although our core service is community health programs, we believe we must support transportation improvements in our area. If we can help solve a significant issue such as transportation, we will enhance the health and wellbeing of our community which, in turn, assists in achieving our mission of being an advocate for healthy living.

What are some of the opportunities and avenues for collaboration in the industry, as well as to the importance of communication for engagement?
We absolutely have to collaborate to address the impact of chronic disease in new ways that activate and engage patients in self-monitoring their conditions and in undertaking lifestyle modifications where needed. In addition, involving patients in the story telling and testimonials that share the benefits also would further personalize the impact of population health and ultimately, conserve valuable resources for both providers and consumers.

______

Guest Blog Post Disclaimer CCA invites guest bloggers to post on Voice on Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health. The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

Guest Post: Walgreens Community Based Population Health Management: Targeted, Coordinated and Connected Care

As part of its ongoing efforts to transform community pharmacy, and recognizing the important role its pharmacists are positioned to play in healthcare today, Walgreens in January 2013 became the first retail pharmacy chain to gain CMS approval to operate Accountable Care Organizations in collaboration with three physician partners. The ACOs’ objective is to meet the triple aim of improving healthcare delivery and patient satisfaction while lowering total medical spend.

The current healthcare landscape has paved the way for Walgreens to expand its clinical services to meet the demands for greater access, convenience and affordable healthcare. Walgreens’ ability to help identify, manage and control health issues in the community complements physician care delivery to provide an extra level of care and the ability to coordinate care across the continuum.

Walgreens’ 8,100+ pharmacies, 400+ Healthcare Clinics and 70,000+ trusted health care providers deliver high quality, personalized services and comprehensive care in thousands of communities nationwide. Its retail pharmacy, infusion services, Healthcare Clinics, specialty pharmacy, employer-based health centers, and host of consumer, hospital and gap management programs offer a comprehensive and unique portfolio of healthcare services to support partners’ care models and patient population, while making Walgreens a strategic partner of choice for a growing number of hospitals, health systems and physician groups.

Health Care Reform offers new opportunities for Walgreens pharmacists to play a key role in integrated care teams and work collaboratively with physicians to provide patient centered care. When pharmacists have participated in integrated care teams, there have been reduced hospital readmissions, enhanced care coordination, improved medication adherence and improved outcomes. (Health Affairs, 2013)

The significant opportunities for population health management exist in collaboration between physicians and community providers, such as pharmacists and nurse practitioners. Walgreens community based population health management strategy extends the primary care driven care plan to leverage all of Walgreens nationwide health care assets in a targeted, coordinated and connected fashion.

The value of the community providers offers patients seamless and convenient access to high quality care that is coordinated with the original physician care plan. Where traditional care management focuses on the complex chronic patients only, Walgreens healthcare touch points provide patient engagement opportunities to maintain healthy behaviors, modify high risk behaviors, control chronic conditions, manage acute conditions, provide education for health delivery choice and reduce readmissions.
There is approximately $700B of waste in the American Healthcare system, with 33%-69% of hospital admissions resulting from poor medication adherence (IMS Health, 2013). By working collaboratively with other providers in the healthcare community, and introducing innovative programs and services that foster coordinated care to help meet the triple aim, we can have a significant impact on the nearly $213 billion cost to the U.S. healthcare system that comes from non-adherence to medications (IMS Health, 2013).

Walgreens medication therapy management and adherence programs provide patients with follow-up calls and full medication reviews. Patient engagement is key to success. Patients who are involved in care planning can better understand their options and can be accountable for their care. As more systems take more risk in the health care spectrum, Walgreens looks to partner with more integrated, risk-bearing entities to provide targeted, connected and coordinated approach to care delivery.

______

Guest Blog Post Disclaimer CCA invites guest bloggers to post on Voice of Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health. The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

Guest Post: Creating Value through Effective Member Engagement in 2014

kellmore_largeBy Kathleen Ellmore, Vice President, Consumer Engagement, Silverlink Communications

With the advent of the ACA, consumerism has become both mandatory and immediate. Creating value, especially in the eyes of the consumer, will be a tremendous opportunity for health plans and others in 2014.

Engagement through communications will be key, especially since healthcare insurance is an abstract product. Consumers can now vote with their feet in the same way they operate with the rest of retail world. Effective communications give health plans the ability to create proactive, cohesive, engaging experiences that will validate the consumers’ plan choice, as well as build trust between the plan and its membership.

Data management and analytics will increase in importance. While health plans already have a variety of data, they now need to capture the new class of engagement data to understand what is motivating members to change behavior. Tools and technology to capture, analyze and share the combined data and insights across the organization will be critical. Once plans unlock the secrets of behavior change on both an individual and aggregate level, they will have the keys to solve the complex equation of improving health and lowering costs.

Becoming member-centric is a company-wide sea change. Understanding and respecting consumer preferences will be a “must-have” for competing in the new world of healthcare consumerism. In addition to gathering language, channel and frequency of communication preferences, communications need to be coordinated across all channels and departments to speak with the member in one voice.

Increasingly, consumer health engagement will be mobile, fast and personal. Multichannel efforts will continue as proven vehicles for smart, results-oriented communications and member engagement. According to a recent infographic from mobile services company GreatCall, 52 percent of smart phone users already gather health-related information on their phones. Additionally, 83 percent of participants in a recent health consumer engagement program completed by Silverlink indicated that SMS text messages helped them think about or make lifestyle changes such as eating better or getting more exercise. Finally, consumer research is going to be an avenue of change. Gathering consumer attitudinal and behavioral data will provide additional opportunities for health plans to know their members and understand what consumers perceive as relevant value.

Undoubtedly, the industry is on the verge of an historic change and evolution. Many plans are redefining their member relationships to drive lower costs and create value through becoming more member-centric. As we move through 2014, effective consumer engagement will lead to improved health, the best value of all.

______

Kathleen Ellmore is Vice President, Consumer Engagement, at Silverlink Communications, the proven leader in engagement management solutions for healthcare organizations. Our solutions enable health plans and other key stakeholders to engage and support their members in smarter and more effective ways. We deliver better control, coordination and effectiveness in member communications to promote healthy and loyal behaviors.To learn more about what makes Silverlink the leader in consumer health engagement, please visit http://www.silverlink.com, email info@silverlink.com, or call 1.781.425.5700.

______

Guest Blog Post Disclaimer CCA invites guest bloggers to post on Voice of Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health. The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

 

Improving Population Health: Creating Healthier Communities to Make Healthcare Better

Brenda Schmidt, MS, MBA, President and CEO of Viridian Health Management

A few weeks ago, I attended the 2013 CCA Forum in Scottsdale, Arizona. I am proud that Viridian Health Management was a CCA Forum contributor sponsorSolution Zone exhibitor and symposium speaker, as this conference is the largest gathering of healthcare professionals in prevention, wellness and chronic care management.

The days started early with the breakfast symposiums and were followed by sessions led by well-known organizations as Accenture, Aetna, Alere, Apixio, Banner Health, Optum, Mayo Clinic, Qualcomm, stickK, Walgreens, Weight Watchers, Zamzee, and many more. The days ended with great networking events in the evening. Despite the long days, I was completely energized and refreshed. Spending three days with over 1,000 innovative thinkers can certainly have that effect. I was fortunate to talk with many of these innovators throughout the duration of the CCA Forum and the common thread was that they all wanted to improve healthcare delivery, positively impact health outcomes, increase quality of care, and make sustainable improvements in healthcare for the future.

Looking back at the many CCA Forum speakers, they all were very aligned to this year’s theme of “The Value of Population Health: Implementation Matters.” Here are a few of those examples that really resonated:

  • Michael Taylor of Accenture: “Maintaining a ‘human touch’ in your engagement methodology is a key component of a successful wellness program. Sustainable engagement is necessary to drive value in population Health.”
  • Nilay Shah of Mayo Clinic: “Big data gives the opportunity to collaborate, to prototype, test new findings and speed adoption.”
  • William Crown of Optum Health: “Creating the right cadence for population health management is the key to success over a shotgun approach.”
  • Dee Edington of Edington Associates: “There is plenty of evidence to show health improvement and improved productivity as a result of a culture of health.”
  • Thomas Parry of Integrated Benefits Institute: “If ROI is your only driver for worksite wellness initiatives, then you’re missing out.”
  • Sean Sullivan of the Institute for Health & Productivity Management: “It’s about a consistent message from the top to create a culture of health at your organization.”
  • Robert Stone of Healthways:  “The things that can be measured the most, oftentimes are not the most important.”
  • Ron Weinert of Walgreens: “It’s not a complicated idea…provide patient care in a community setting. We’re bridging the gap…coordinating care through innovative pharmacy programs.”

It was also an honor to co-present with Marissa Hudson, Viridian’s EVP of Public/Private Partnerships at CCA Forum 2013 to discuss Viridian’s role as a strategic partner of the CDC to deliver the National Diabetes Prevention Program (National DPP); Viridian’s proprietary My Weigh 2 Prevent Diabetes™, a cloud-based technology developed exclusively for the National DPP; our diabetes lifestyle coach training; andMAESTRO™, Viridian‘s proprietary model for the identification, outreach and administration of diabetes prevention.

In addition, I am honored and privileged to accept my appointment as a member of CCA’s board of directors. As one of 10 new members of CCA’s board of directors, I look forward to collaborating with other leaders of the healthcare industry to focus on the implementation of effective population health models and strategies from development to delivery.

It’s not a complicated idea: creating healthier communities to make healthcare better and sustainable for the future. As a value-driven health management company, Viridian powers performance in population health, inspires healthy living and lowers healthcare costs. Our philosophy of integrative health management is an interdisciplinary approach that emphasizes a synergy between health protection and health promotion. This approach extends not only to individuals, but also to caregivers, providers and the larger healthcare system.

CCA Forum 2013 clearly chose a very relevant and timely theme. Without a doubt, there is tremendous value of improving population health…it really does matter.

______

About the Author

Brenda Schmidt is the president and CEO of Viridian Health Management. As the architect of numerous successful health and wellness programs, Schmidt is widely recognized as an authority on developing best-in-class programs that engage diverse populations. In founding Viridian, Schmidt works in collaboration with the Centers for Disease Control and the U.S. Department of Health and Human Services on the National Healthy Worksite Program. This national initiative brings a new level of health to the American workplace to improve the lives of employees while lowering employer healthcare costs. In addition, Schmidt also serves a leadership role in the Health Enhancement Research Organization (HERO) Think Tank, the Clinton Global Initiative (CGI), NIOSH Total Worker Health™ and frequently speaks nationally on integrated health management and worksite health.

______

Guest Blog Post Disclaimer CCA invites guest bloggers to post on Voice on Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health. The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

%d bloggers like this: