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Incentives studied to align care, coverage and wellness
Date:10/4/2010

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 helpe
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Contact: Rebecca Hughes
hughes.r@ghc.org
206-287-2055
Group Health Research Institute
Source:Eurekalert

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