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Blue Shield Spotlight

Legislative Corner

By Tom Epstein

The health coverage expansion compromise brokered by Governor Schwarzenegger and Speaker Nunez has now fallen by the wayside. A defeat in the Senate Health Committee Monday ended its chances for the year. What happens next?

Despite this loss, coverage expansion is squarely on the agenda, both in Sacramento and in Washington, D.C. When you listen to the primary debates among the presidential candidates, it's certain that 2009 will bring a vigorous debate on national healthcare reform.

It's also clear that there is a choice in this debate between sensible reforms that will build on what works in today's healthcare marketplace, and ill-considered schemes such as single-payer that will undermine those market dynamics and ultimately do more harm than good.

Blue Shield's role in this process -- as a longstanding advocate of universal coverage -- is to do everything we can to make sure that reforms make the insurance market work more effectively. A key example of our efforts is the provision we succeeded in persuading Governor Schwarzenegger and Speaker Nunez to add to their coverage expansion bill that protects the role insurance brokers play in helping people find the best coverage for their families.

Specifically, this amendment would block a requirement some have proposed that health plans not pay broker commissions on products sold through the new state purchasing pool that the bill will create. Legislative language drafted by Blue Shield and the California Association of Health Underwriters makes clear that commissions are a matter for plans and brokers to decide between them, and that the state cannot interfere in that relationship.

Whatever state or federal laws are ultimately enacted, we must make sure that those of us who actually understand the health care marketplace be actively involved in shaping critical details like those. Blue Shield remains committed to continuing to play a leading role in doing just that, so that reform works for all Californians.

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Healthy Programs Help the Bottom Line

With the cost of health care on the rise, employers continue to look for ways to combat this trend and provide programs that can help manage plan costs.

Employers also face the challenge of an increasingly unhealthy workforce, which affects workplace productivity and company performance.

Numerous studies show a clear linkage between increased health costs and modifiable health risks. For example, individuals with just one health risk have 80% higher annual costs than those with no risks1.

Employer groups are transitioning to health plans that include targeted behavior modification or lifestyle management features to help meet these needs.

Health plans, in turn, are now focusing on member behavior modification through programs, incentives and tools. Members can be classified into various categories for follow-up interventions by using available risk and health status information such as a health risk assessment (HRA), biometrics, medical and prescription drug claims data, demographic information, etc.

Once members are classified as high-risk, low-risk, or in need of acute health management for disease/chronic conditions, members can be referred to any and all interventions appropriate for them within a health management program. One example is the use of HRA results to refer a high-risk individual to a lifestyle management program.

Health and lifestyle coaching have emerged as widely used health management intervention. With advances in technology, coaching and counseling can now be delivered in a variety of ways beyond traditional, face-to-face meetings, such as over the telephone or by email.

But employers are looking to wellness programs not just to reduce direct costs, but to improve indirect costs like worker productivity, because high-risk employees have 10-32% higher absenteeism compared with employees with no health risks2. It's also good to know that more than half of employees feel a wellness program strengthens their loyalty to the company and motivates them to work harder and better3. The impact on these indirect costs by health management programs are being watched closely. Recent reviews of the literature have noted some of these impacts.

Out of 56 peer-reviewed studies examined, Chapman found that 25 measuring absence showed an average 27% reduction; that the seven studies that measured impact on disability and workers' compensation showed an average 32% reduction; and finally, that 28 studies showed an average reduction of 26% in health care costs4.

Blue Shield launched Healthy Lifestyle Rewards (HLR) in 2004 as a way to help members adopt a healthier lifestyle, and thereby decrease their health expenses. This integrated, online program includes information about diet and nutrition, meal planning, exercise, stress, and smoking cessation, and features a variety of interactive tools designed to motivate members to adopt a healthy lifestyle.

Large employer groups (1500+) can upgrade the HLR experience by rewarding their members (regardless of health plan choice) with cash and prizes. The upgrade includes rewards administration, reporting, and marketing for a nominative PEPM cost. The regular program, without rewards, is available to all groups (with few exceptions) at no additional cost. Participation rates for program users with monetary incentive demonstrate 30% higher rate of participation and program completion than users with no incentive.

In addition to the successful standard or upgrade versions of HLR, Blue Shield now offers Health Coach to large group employers (300+) as an added feature to help improve member wellness and ultimately, help members be more productive in the workplace.

Health Coach is a personalized telephonic support program that aims to change behaviors that are associated with poor health outcomes and reduced productivity. It's designed for people with health risks and provides structure and support for participant efforts to set and achieve behavior goals.

The program lasts for a 12-month period and focuses on modifiable behaviors such as quitting smoking, weight management, stress management, fitness and nutrition. Coaches can assess readiness to change and prioritize specific goals, then provide education and support for healthier living. Also, participants have unlimited access to their health coach.

Employers are encouraged to purchase Health Coach with the Rewards version of Healthy Lifestyle Rewards to motivate and thereby increase member participation.

These programs are just two ways that shows Blue Shield's commitment to helping employers manage their healthcare costs. We know that it is more cost effective to keep the low risk person low risk than to bring the high-risk person to low risk.4.

For more information about these programs or others that can help your client improve their members' wellness, contact your Blue Shield representative.

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1 Yen, Louis, et al., AJHP, Sept/Oct 1991, p. 46-54
2 Journal of Occup Med. 1991;33: 1119-1124
3 Principal Financial Well-Being IndexSM  survey, Jan 2007
4 Best Practices for an Integrated Population Health Management (PHM) Program by Seth Serxner, Steven P. Noeldner, and Daniel Gold, The Art of Health Promotion May/June 2006
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