Health Plan Design That Works for Your People and Your Bottom Line

Here's how we helped one client with health plan design

Here's one example of how we helped a client design a wellness program that met their specific needs and lowered their overall costs.

The issue

Our client, who was looking to build more rigor into its wellness program, requested our help in enhancing its program.

Our solution

Our consultants worked closely with the client to establish program goals, design and implement new program features, facilitate more impactful employee communications and measure program results. Highlights included the following:

Introducing a value-based plan design: The new design features lower out-of-pocket costs for participants who select a primary care physician, complete a Health Risk Assessment and obtain age/gender appropriate screenings as recommended by their primary care physician.

Implementing outcomes-based performance guarantees: Through an innovative risk-sharing arrangement we helped develop, each of our client’s health plan vendors has significant financial incentives to drive better health outcomes for the employees it covers. The goal of the shared savings program was to partner with the client’s health plan vendors to improve the health risk profile of the covered population and close the gap from a baseline measurement period from when the program was first implemented to goals established year over year. On an ongoing basis, we collect data from the health plan vendors and analyze health outcomes through our SHAPE data warehouse. Vendors are rewarded or penalized each year based on changes in health status of their plan’s members, as determined by measures such as:

• An increase in diabetic participants with HbA1c tests of < 8.0
• A higher percentage of participants with blood pressure control of < 140/90
• A higher percentage of participants with cholesterol levels below 220mg/dL
• A higher percentage of participants age 50–75 who have had appropriate colorectal cancer screening every two years
• A higher percentage of participants with major cardiac events, COPD, asthma, or congestive heart failure that do not require readmission within 30 days of discharge.

Boosting participation in health coaching: Working closely with our client and its health plan vendors, we helped create a custom communications campaign to drive more participation in each vendor’s health coaching program. The campaign stressed “what’s in it for me” for employees and featured postcards, a video posted to the client’s website and promotional posters, in addition to getting each vendor to use consistent messaging in their own outreach to members.

The result

As a result of these and other programs that we have helped design and implement, our client achieved nearly $70 million in net health plan savings over the last three years. Additionally, over half of the client’s employees have completed required screenings (a significant improvement from screening rates prior to our collaboration with our client). Moreover, as employees have reduced their risk factors for chronic diseases, our client’s health plan has experienced lower-than-benchmark trend rates on costs for employees with diabetes, hypertension, hyperlipidemia, heart disease and asthma/COPD.