Highmark Value-Based Benefit Designs Incent Employees To Get Engaged In Health Care
March 30, 2012
PITTSBURGH – Highmark Inc. recently introduced to its group customers a comprehensive package of value-based benefit designs, which are more commonly known across the industry as health insurance plan designs that offer incentives and rewards for employees to become more engaged in their health care.
“Value-based benefit designs are a broad spectrum of tools that are used like ‘carrots’ and ‘sticks’ to push and pull members towards appropriate care,” said Steven Nelson, senior vice president of health services strategy, product and marketing at Highmark. “Rewards, like cash and gift cards, and incentives, like lower cost-sharing through benefit designs, have proved to be important tools to encourage employees to better understand and more effectively utilize health care.”
With Highmark’s value-based benefit design programs, employers can:
- Reward employees for preventive care and completion of a wellness profile.
- Reward employees who reach health results based on medical standards such as targeted cholesterol or blood pressure levels, a specific BMI target and more.
- Incent employees with such chronic conditions as asthma, diabetes, high cholesterol and more to improve compliance with medical protocols including taking their medications or visiting the doctor. A unique feature of Highmark’s program is the ability to adjust a member’s benefits, either up or down, on a quarterly basis, according to his or her compliance with the protocols.
- Incent employees to understand medical procedures that they might be considering for which evidence-based guidelines are inconclusive such as knee or hip replacement, back surgery and more, and consider less invasive alternatives to these procedures.
“Our group customers can mix and match from whatever type of program bests fits their needs,” said Nelson. “We help them understand where their costs are. Is it a few employees with high-cost chronic conditions within the company that are driving up costs or is it a broad base of general wellness concerns? Either way, and everything in between, these value-based designs can help.”
More than a dozen businesses across Highmark’s service area are currently implementing value-based benefit designs with their workforce.
Holy Family Institute, a children and family services nonprofit based in Pittsburgh, introduced a value-based benefit design to incent its employees with chronic conditions, including asthma, depression, diabetes, high cholesterol and hypertension, to get the medical care needed to treat and control these conditions. Holy Family employees who sign up for the value-based design and agree to work with a health coach on their condition pay no deductible on the medical services eligible to treat these conditions.
“It’s important to be able to offer health care coverage to our employees, but we also recognize that as a business, we have to be able to do it at a cost that’s affordable to us while continuing to provide a competitive benefits package,” said Kim Radler, human resources director of Holy Family Institute. “Chronic conditions make up a lot of health care costs across our organization, and Highmark’s value-based benefit program allows us to work with our employees to get the care they need to control their conditions, and ultimately, lower health care costs.”
The Patient Protection and Affordable Care Act of 2010 also recognizes the importance of value-based benefits by defining these designs as “information and incentives for consumers that promote access to and use of higher-value providers, treatments and services.”
“Everyone is concerned about rising health care costs, and the million dollar question is ‘how can we slow the trends?,’“ said Cyndy Nayer, Center for Health Value Innovation president. “A value-based program like Highmark’s is important because it uses multiple levers, or incentives, to draw a wider circle of engagement. Highmark’s plan merges the most up-to-date information on priorities and successes in value-based design, and it offers the options to their plan sponsors. Businesses who offer these programs to employees can engage them in their health care and ultimately, lower overall health care costs with a predictable cost trend.”
About Highmark Inc.
Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.8 million members in Pennsylvania and West Virginia through the company’s health care benefits business and is one of the largest Blue plans in the nation. Highmark has 19,500 employees across the country. For more than 70 years, Highmark’s commitment to the community has consistently been among the company’s highest priorities as it strives to positively impact the communities where we do business. For more information, visit www.highmark.com.
The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally-operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 106 million members members – one-in-three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.