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Incentives studied to align care, coverage and wellness

The effectiveness of Total Health, a unique benefits program for Group Health Cooperative employees, is the subject of a four-year study that the federal Agency for Health Research and Quality (AHRQ) recently funded. It's part of a trend to integrate care, insurance, and wellness programs and base them on research findings. The goal is to help people stay healthier and control health care costs.

Launched in January 2010 and available to all 9,000 Group Health employees, the Total Health benefits program exemplifies "value-based insurance design." That means employers are using financial incentives in a "carrot and stick" approach to nudge employees toward those treatments and preventive measures that research has proven work best.

For example, preventive care such as vaccinations and appropriate cancer screenings are free or low cost to enrolees. And copayments are reduced for visits and medications for managing chronic conditions, explained David Grossman, MD, MPH. Group Health's medical director of preventive care and a senior investigator at Group Health Research Institute, Dr. Grossman is leading the multidisciplinary evaluation of the program. Meanwhile, unneeded high-tech imaging and emergency room visits may have associated charges or co-payments to discourage unnecessary use of expensive medical services.

This evidence-based alignment of care, insurance, and wellness programs contrasts with traditional health insurance packages, he said: They set up co-payment and co-insurance fees without considering how treatments and procedures affect people's health.

Total Health aims to increase the value of health insurance and maintain healthy employees by:

  • preventing costly future care by managing chronic conditions
  • limiting "overtreatment"excessive or unnecessary procedures that may cause needless side effects
  • encouraging participation in a health promotion program

As Dr. Grossman helped develop Total Health, he recognized a chance to conduct a natural experiment on the plan's implementation. He got Group Health Research Institute funding early on, to collect preliminary baseline data on participants. With the AHRQ-funded evaluation, scheduled to begin this fall, he can now see how Total Health affects factors such as chronic disease control and quality of life among its enrolees.

Employers will be particularly interested in the study's analysis of how the value-based health plan affects worker productivity and health care use and costs. The study will compare Total Health participants both to the preliminary "before" information and to a control group of Kaiser Permanente Colorado employees who have a conventional, non-values-based health plan.

The results may influence health care across the nation. "By studying worker productivitynot just health outcomeswe're addressing a key issue from the employer's perspective," Dr. Grossman said. "Purchaser interest in this approach is growing, and Group Health is planning new value-based insurance products for the market."

Co-investigator Paul Fishman, PhD, an associate investigator at Group Health Research Institute, brings expertise in health economics to the study.

"This evaluation will help us understand how to improve these products, and stay competitive," Dr. Fishman said. "Through Total Health, Group Health is implementing and evaluating innovative delivery and payment models."

"This is an exciting pilot whose goal is to demonstrate improved health and productivity for our workforce," said Cindy Johnson, Group Health's executive vice president, human relations.

Total Health parallels the health care reform law that President Barack Obama signed in March 2010. Like Total Health, national health care reform promotes free preventive care services such as tests for chronic illness, routine vaccinations, and prenatal and well-child visits. Group Health Research Institute's evaluation of Total Health is in keeping with the mission of the AHRQ, which is part of the Department of Health and Human Services and promotes research on evidence-based treatment decisions that improve the country's health care quality, safety, efficiency, and effectiveness. The first progress report from the study is scheduled to be available in 2011.


Contact: Rebecca Hughes
Group Health Research Institute

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