- To reduce payer claim costs, would you pay members to go see their doctor once a year? That’s the premise for a wave of patient incentive programs currently being offered by health insurance companies.
For healthcare insurance payers, it’s just good business to have a healthy member base. This starts with annual preventive care visits.
“These visits with a primary care provider (PCP) are a vital step in completing needed screenings and early detection of any chronic conditions,” says Dr. Jan Cook, CMO of Minuteman Health. “Assisting our members in establishing primary care relationships and encouraging them to get recommended screenings is one of our main priorities,” she told HealthPayerIntelligence.com.
“It helps them, and us, make sure that they have early identification and treatment of illnesses in a cost-effective setting. It also empowers members to manage and track their own health.”
Minuteman Health is a non-profit HMO which serves the Massachusetts and New Hampshire individual and small business marketplace. Cook, as CMO, has been a strong proponent of the MinuteMember Wellness Rewards program.
Members who establish PCP relationships have overall lower healthcare costs. Preventive care allows physicians to monitor and manage chronic diseases and proactively identify emerging health issues. The subsequent decrease in ER visits and specialty referrals also reduces payer expenses.
According to Cook, three main objectives of a wellness incentive program are to get members to establish a close relationship with their in-network PCP, to receive recommended screenings and immunizations, and to offer providers the opportunity to intervene with any health issues before they advance to chronic or life threatening levels.
“Having members establish a relationship with an in-plan PCP is a good first step in identifying chronic medical issues,” said Cook.
Patient incentives help to sweeten the deal for members who may not otherwise see value in making an appointment. The MinuteMember Wellness Rewards program started in May 2016 and is available to any fully insured member over 18.
“The only thing an eligible member must do to receive the $50 incentive check is to visit their In-Plan PCP during the calendar year. Once we receive the claim, they will receive their check. There is no paperwork for them to fill out,” explained Cook.
“In its first year, approximately 9300 members (or 40 percent) received an incentive check through the
Other payers are exploring similar patient incentive solutions.
At Tufts Health Plan (THP), members are offered a $55 health rewards card upon completion of their annual PCP visit. The card allows the member to make health-related purchases.
According to the THP website, the member can use the rewards card to purchase “prescriptions, contact lens solution, and/or first-aid supplies, at participating pharmacies, grocery stores, and even the doctor’s office for co-payments.” There is also an online store where members can redeem their reward for qualifying purchases.
For other payers, the wellness incentive is focused on getting members involved with their healthcare as soon as possible.
WellCare, a payer who exclusively provides Medicare and Medicaid programs in Georgia, has a Healthy Awards Program. If a member sees their PCP within the first 90 days of being a plan member, they can go on to the WellCare website and print out a $30 reward voucher.
Cook noted an additional benefit to wellness incentive plans. Not only are members receiving primary care and any needed-follow up, but they are doing it with an in-plan, payer-approved provider.
“There is a segment of every member pool which will not seek medical treatment unless it is for acute or catastrophic conditions,” said Cook. “The evolution and popularization of wellness incentive programs by providers is making inroads to motivate members to take a preventative approach to healthcare.”
For insurers who do not have an incentive program, Cook has some advice. “They are missing out on a chance to engage members, healthy and ill, in a positive way that impacts members health and insurance company's bottom line”