IN THE PIPELINE: Health Plans Make Exercise Pay Off
In an effort to pry their members off the couch and into healthier lifestyles, a rising number of health plans are offering everything from health club memberships to European vacations to those who exercise, lose weight or quit smoking.
PacifiCare Health Systems Inc., one of the largest health maintenance organizations in California, next month will launch a new program called Health Credits, which will reward points to participants whenever they engage in healthy activities. Those who earn enough credits can take part in drawings for free exercise equipment or win a new mountain bike, while others will earn discounts on premium rates or lower co-payments for visits to the doctor's office.
"Now, for the first time, consumers have incentives to do the right thing," said Dr. Sam Ho , PacifiCare's chief medical officer.
PacifiCare is the latest among a small group of health insurers, including Aetna Inc. (AET), Wellpoint Health Networks Inc. (WLP) and Destiny Health, that use prizes and rewards to entice members to take better care of themselves and reward their healthiest members. Prizes can range from gift certificates and T-shirts to free airline tickets to Europe, and even extra money to pay their medical bills.
The idea takes a page from the auto insurance industry, which offers lower premium rates to policyholders who maintain a clean driving record or install car alarms. But among health insurers, it remains a fairly uncommon practice, though not for long.
"This is definitely the wave of the future," said Jeff Black, a consultant with Mercer Human Resources Consulting, one of the nation's largest employee benefits consulting firms.
Several HMOs are considering reward programs, including Cigna Corp. (CI), which has a pilot program under way. Meanwhile, Aetna, one of the nation's largest health insurers, plans to expand a program that rewards participants for filling out an online questionnaire about their health and then following the insurer's suggestions to reduce the risk of illness.
The cost of these programs for insurers isn't clear. Officials at Destiny and PacifiCare said it is "marginal," though neither company provided figures.
But both insisted there are myriad cost savings for insurers, employers and even health plan members if they lead healthier lives. The programs also boost enrollment, offering patients, especially those in good health who rarely file insurance claims, a reason to stay with a particular insurer.
"Over time, everyone wins. Consumers have incentives and can stay healthier longer. Employers win because they get a healthier and more productive work force. And PacifiCare wins because it develops brand loyalty to their health plans and helps manage costs," Ho said.
Creative Cost Savings
Insurers and employers are becoming increasingly creative about finding ways to lower medical costs and control premiums after enduring four consecutive years of double-digit cost hikes.
For years, insurers were accused of blocking patients from accessing care to boost profits. Now, many health plans have invested heavily to keep their members healthy, reasoning that healthier patients cost less in the long run, even if expenses rise initially.
Some health plans monitor patients who are overweight or suffer from chronic illnesses, such as heart disease or diabetes, and encourage them to visit their doctor regularly and take their medicine. Other health plans offer their members discounts to gyms, weight-loss programs and smoking workshops, as well as coupons for prescription medications.
But industry authorities, as well as wellness experts, argue this is not enough.
Despite years of public service announcements and dire warnings from doctors, obesity and smoking remain epidemic in the U.S. Also, a growing number of patients in their 30s have been diagnosed with diabetes. And more than 60% of adults do not get enough physical activity, while more than 24% of adults are not active at all despite doctors' recommendations, according to the U.S Department of Health and Human Services.
Of course, rewards and incentives are not a magic bullet, insurance and wellness experts say. But they do provide positive reinforcement to patients willing to change their lifestyle. Combined with education and other efforts, that can make a difference, said Ken Linde, chief executive of Destiny Health in Oak Brook, Ill.
"I think every little bit of incentive you can give a human being adds to their desire to quit smoking or exercise. Just the fact that it will make them feel healthier is not necessarily enough," Linde said.
If you are one of the 23,000 patients insured by Destiny Health, incentives include health club memberships, free movie tickets and weekend stays at Hyatt resorts.
Known as the Destiny Health Vitality Program, the program was launched two years ago after the success of a similar plan in South Africa run by Destiny's parent company, Discovery Health. Participants are awarded points for taking a CPR class, starting an exercise program, losing 10 pounds in six months, checking their cholesterol level, using the Internet to look up information or buying generic, rather than brand-name, drugs.
"I get more excited about the fact that I am getting something," said Mary Ellen Alfred, 58, director of administration at Salco Products Inc., a Lemont, Ill., manufacturer whose employees are covered by Destiny Health. Alfred hopes for a weekend getaway as a reward for her daily exercise, which includes swimming, walking and yard work.
"I have had a lot of coworkers say they have been looking for something that would reward them and it has inspired them to do things they would not normally do," Alfred said.
That seems to be the case with Joe Bollero, an insurance broker in New Lenox, Ill., and his wife. Though both exercise regularly, they are planning to participate in a bike tour through southwest Michigan because it will earn them 2,000 points each.
The pair want to take a trip to Hawaii or St. John and hope to win enough points to cover their airfare.
"Would we have done this anyway? I don't know. But there is an incentive for it," Bollero said.
Today, about 93% of Destiny's 23,000 health plan members participate in the Vitality Program, Linde said. And according to a recent study, about 79% of the company's members have started an exercise or nutrition program in the last 12 months.
But how many will keep it up? That's hard to say, according to experts in the wellness field.
Behavioral changes are complicated, relying on a person's readiness and habits, which are hard to change, said Ilene Masser, director of the New York University Corporate Wellness Program in Manhattan. And while incentives can help push some people into a new direction, they are not necessarily a guarantee that some won't return to old habits, she added.
"In and of itself it is not enough to cause me to make lifestyle changes," said Kathryn Adams, a 40-year-old New jersey resident who has been advised by her doctor to lose weight and exercise. Her insurer does not have an incentive program, though Adams said she does want to follow her doctor's advice.
"If a person is a real couch potato, it is not going to get them up off the couch," Adams said.
健康保险商的“双赢”策略
终日懒散在家将难有斩获。
为了促使其保健计划会员告别慵懒的日子，过上更健康的生活方式，越来越多的医疗健康保险商正在采取激励的办法，向那些锻炼身体、减肥或戒烟的会员提供健康俱乐部会员资格甚至到欧洲旅行的好处。
加利福尼亚州最大的保健机构之一PacifiCare Health Systems Inc.下个月将推出一个名为“健康积分”(Health Credits)的新计划，一旦会员参加健康锻炼活动，他们的积分就会增加。当积分达到一定的时候，会员就可以参加免费健康锻炼器材的抽奖，或者赢取一辆全新的山地车。一些人还可以在健康计划缴费上获得优惠，或者看病时减少自付费部分。
PacifiCare首席医疗负责人Sam Ho称，消费者现在有动力去做合适的事情。
用奖赏和报酬鼓励会员更好地保重身体并对身体最为健康的会员给予奖励，PacifiCare只是新近加入的一家公司，包括安泰保险公司(Aetna Inc., AET)、Wellpoint Health Networks Inc. (WLP)和Destiny Health在内的数家健康保险商已经有了这样的行动。他们提供的奖品包括礼券、T恤衫、到欧洲的免费机票，甚至额外资助医疗费用。
这种思路是从汽车保险业受到了启发。在汽车保险里，如果保险客户驾驶记录良好或安装了汽车报警器，他们支付的保险费率就会低一些。但在健康保险行业里，这种做法由于刚采用不久，因此还不普遍。
Mercer Human Resources Consulting的咨询师杰夫?布莱克(Jeff Black)认为，提供激励的办法肯定是未来的发展趋势。Mercer Human Resources Consulting是美国最大的雇员福利咨询公司之一。
几家医疗保健组织正在考虑实施奖励计划。信诺保险(CIGNA Corp., CI)的小规模计划正在试行当中。安泰保险则准备扩大一个计划，对那些参加网上健康调查并按照其建议减少患病风险的客户提供奖励。
保险公司实施这种奖励办法的成本不得而知。但Destiny和PacifiCare的管理人士都称“微不足道”，不过他们都没有提供具体的数字。
两家公司都坚称，如果会员生活方式健康，这种计划能为保险商、雇主甚至健康保险计划会员本身都节省很大的成本。这种办法还有助于提高投保率，尤其有助于身体健康且很少申请保险索赔的投保人和某一保险商保持长期的保险关系。
Ho说，从长期来看，每一方都是赢家。消费者得到激励，能够更长期内保持身体健康。员工身体健康且更具生产力令雇主受益。PacifiCare等保险商则提高了其健康计划的品牌忠实度，并有助于控制成本。
节约成本创奇招
在连续4年成本出现两位数的上涨后，保险商和雇主在降低医疗成本和控制费用上可谓费尽心机。
多年来，保险商被指控为提高利润不惜为病人就医设置障碍。而现在，许多保健计划则著力于在保持会员身体健康上进行投资，理由是虽然起初费用会上升，但会员身体更为健康从长远来看会令其担负的成本减少。
一些保健计划监控超重或患有心脏病、糖尿病等慢性病的病人，鼓励他们定期就医并服药。其他一些保健计划则为会员提供体育馆、减肥和戒烟研讨会的费用折扣优惠，以及治疗药物的优惠券。
但业内权威人士和健康专家认为这还不够。
虽然年复一年的公共卫生状况声明和医生的严重警告，但肥胖症和吸烟问题在美国依然大行其道。根据美国卫生与公共服务部（卫生部）(U.S Department of Health and Human Services)的数据，30多岁就患上糖尿病的病人日渐增多。超过60%的成年人身体锻炼不足，而超过24%的成年人根本没有按照医生的建议积极从事体育运动。
保险及健康专家说，诚然，奖励和激励并非魔方，但其的确为病人改变生活方式提供了积极的推动作用。Destiny Health的首席执行长肯?林德(Ken Linde)认为，通过教育和其他努力，这能够产生效果。
他说，每一小点激励都会增加人们戒烟或加强锻炼的愿望。但只是说会使他们变得更加健康并不足以改变他们的行为。
如果你是Destiny Health承保的23,000人士之一，你能享受到的好处包括健康俱乐部会员资格、免费电影票和免费到凯悦(Hyatt)休闲度假地过周末。
Destiny Health的保健计划Destiny Health Vitality Program是两年前发起的，之前Destiny Health母公司Discovery Health在南非的一个类似计划获得了成功。
该计划参与者的可获得积分，并凭积分参加心肺复苏术(CPR)课程、开始锻炼计划、在6个月减轻10磅体重、测量胆固醇水平、用互联网搜索或购买普通药而非品牌药物。
伊利诺伊州制造商Salco Products Inc.加入了Destiny Health的保健计划。该公司行政主管玛丽?阿尔佛雷德(Mary Ellen Alfred)说，对参加Destiny Health的保健计划有所收获感到兴奋。她希望能得到一次周末度假的机会，作为对她每日坚持游泳、步行和庭院整理等身体锻炼活动的奖励。
阿尔佛雷德称，她的很多同事都表示对得到某种奖励感兴趣，这已经激励他们做平常不会做的一些事情。
伊利诺伊州的保险经纪人乔?博莱罗(Joe Bollero)和他的妻子也是这样。他们准备参加密歇根州西南部的一个自行车游，因为这会为他们每个人增加2,000点积分。
这对夫妇想去夏威夷或圣约翰旅行，他们希望能够攒到足够多的积分，从而赢得免费机票。
博莱罗说，如果没有这种保健计划，他不敢说他是否会这么做。但保健计划的确有激励人的地方。
Destiny首席执行长林德称，如今，Destiny 23,000名保健计划会员中，有大约93%加入了Vitality Program。并且根据最近的一个调查，在过去12个月里，该公司大约79%的会员已开始身体锻炼或注重饮食营养。
但健康专家认为，有多少人能持之以恒还不好说。
纽约大学(New York University)企业健康方案(Corporate Wellness Program)负责人马瑟(Ilene Masser)说，行为的改变很复杂，依赖于个人的意愿和习惯，而习惯是很难改变的。她补充说，虽然激励因素能够推动一些人朝新的方向发展，但这不能保证一些人会回到旧有的习惯上。
新泽西州居民凯瑟琳?亚当斯(Kathryn Adams)表示，通过激励的办法或激励本身不足以改变她个人的生活习惯。医生建议这位40岁的女士减肥并进行体育锻炼，她也表示的确有遵循医生建议的意愿。不过，她投保的公司并不提供激励计划。
亚当斯称，对于那种过惯了慵懒生活的人来说，提供一点刺激就想改变他们的生活方式是不可能的。
