From the February 2004 Issue

Safety First

Moving From Liability to Viability

Investing in the Internet

Right on Schedule

Financial Finesse

Automation for Growth: What Works

Healthier Members,
Happier Employees

A health plan’s unique approach to consumer-driven healthcare attracts new employers.

Like seldom before, health plans today are in a position to influence how productively consumers use and maximize their benefit plans. With the right products and the right information technology to help deliver them, health plans may find themselves having a demonstrable impact on the long-term health gains of plan members. That becomes a winning situation for the plan, the patient and the employer.

PROBLEM
Mercy Health Plans (MHP) is a subsidiary of the Sisters of Mercy Health System (St. Louis) and operates as an HMO in Missouri, Illinois and Texas, providing coverage for 230,000 lives. Like many health plans, we at MHP are faced with the challenge of attracting and retaining employers in a world daunted by rising premium costs. Employers are being forced to either reduce or not offer healthcare benefits, or to shift ever-increasing amounts of healthcare costs to their employees. Not surprisingly, this dynamic is not welcomed by either group.

In addition to these industrywide dynamics, attracting new employers is even more challenging for us as a local health plan. Our top competitors offer national coverage and already own nearly three-quarters of the market share.

To differentiate ourselves from our competitors, we needed to approach the issue of rising healthcare costs at a strategic level. We began encouraging employers’ senior management teams to consider our ideas for long-term solutions to this problem, rather than selecting short-term, cost-shifting solutions offered by typical so-called "consumer-directed" health benefit programs.

We needed to design a program that could improve the overall health of an entire member population, including those consumers who are not currently at serious risk and are not major drivers of healthcare costs. Then, over time, we would be able to systematically reduce the cost element of the healthcare system. Lower costs, in turn, translate to lower premiums and more affordable coverage for employers.

SOLUTION
In 2001, we began developing a new type of "consumer-centered" health management program, MyChoice. By targeting all employees, our program was designed to help employers tackle the toughest part of the healthcare issue: the one-third of employees who account for nearly 80 percent of all healthcare expenditures (while not ignoring other plan members who seek optimized health). These employees typically are currently ill, chronically ill or have advanced, comorbid (multiple) conditions. To truly affect this segment of the population, we realized that information technology would need to play an important role, and that the Internet would likely be the most effective method for delivering this new health management program to employers and members.

We created a search committee consisting of representatives from marketing, health management and information technology and began looking for a partner that could deliver the innovative technology we needed, while at the same time offering us enough system flexibility to ensure that we got exactly what we wanted.

The committee researched about 12 technology suppliers and narrowed its list to two vendors. After comparing the finalists side-by-side, we selected HealthTrio’s Internet-based health management tool, HealthTrio connect. Our decision ultimately came down to three salient criteria:

• a robust personal health record that was already developed and being used by other health plans;

• the flexibility to customize the system to our specific needs;

• the ability to implement the system quickly.

The next step was testing the effectiveness of the program in the marketplace. We selected Pohlman, a Chesterfield, Mo.-based auto parts manufacturer with a solid corporate culture and strong employee relations, as the pilot for the program.

In January 2003, open enrollment for MyChoice was available to Pohlman’s 209 employees, representing 467 members. Members were asked to complete a health risk assessment with questions related to cholesterol, weight management, diabetes, smoking and seat belt use. Each member that committed to improving in these areas became eligible for a reduced premium and a higher benefit level. On March 1, 2003, the pilot program officially began.

Initially, we were concerned that requiring members to use the Internet might impact the number of employees that would sign up for MyChoice. To offset that risk, we worked with Pohlman to set up computer stations in the plant that could be used exclusively by employees to access the Internet-based health management tool. Even considering Pohlman’s estimate that 90 percent of its employees were not regular computer users, more than 75 percent of employees and their spouses signed up for MyChoice.

RESULTS
Early results from the pilot program have been very encouraging:

• 27 percent of the company’s smokers volunteered to participate in a smoking-cessation program, and the program has experienced a success rate of 85 percent that remain nonsmokers.

• 89 percent of the company’s diabetic employees are participating in a case management program for their condition.

• 2 percent of the company’s employees and covered dependents were identified to have a BMI (body mass index) greater than 40. Sixty-three percent of these employees volunteered to participate in a weight-loss program; many of them have lost significant weight.

These results clearly demonstrate that when members are given the opportunity—with incentives—and the appropriate tools to take responsibility for improving their personal health, they embrace it. This enables employers to foster a corporate culture that focuses on wellness and rewards employees who get and stay healthy. Healthier employees, ultimately, spend less on healthcare services.

We have rolled out MyChoice to two more employers in the past year, and are already planning between three and five additional rollouts for 2004. In an important development for us, we are now recruiting new employers—never-before Mercy customers—because of our ability to offer this innovative new approach.

Some employers focused on the short term may be so desperate to shift costs that they may not be able to evaluate a long-term solution such as MyChoice. But others will see the advantages of healthier members, and through this program will take the initiative to control the rising cost of healthcare through healthier employees. Isn’t that the best solution of all?