Employers increasingly see wellness programs as effective ways to reduce the money they spend on health benefits. Health insurers are responding to these employer needs by launching wellness programs aimed at better prevention and disease management.
Such wellness programs often have two dimensions. First, most wellness programs encourage beneficiaries to utilize healthcare in a proactive mode. Beneficiaries are encouraged to receive regular medical check ups, along with preventive tests or screenings consistent with “best practice” protocols by age, gender and health status. This creates an opportunity for medical laboratories to develop services that can add value to the wellness programs offered by employers and health insurers. The second dimension involves efforts to improve lifestyles. Smoking cessation support, encouraging more exercise, and helping people lose weight are examples.
Over at Wellpoint, the nation’s largest health insurer, its regional subsidiary plans rolled out a wellness program called “360o Health.” This program bundles health and wellness programs together for employers. It includes Web-based health support and nurse counseling via phone. Online tools remind members when they’re due for routine tests and checkups or provide tips, such as recommendations on how to obtain less expensive medication options.
Wellpoint, which has 34 million members nationwide, also launched an assessment tool to gauge the program’s success. Its Member Health Index measures success of the WellPoint program in 20 clinical areas, including prevention, screening, care management and patient safety.
WellPoint, which tied its employee bonus structure to patient participation, reports it quickly realized a two-for-one return on its investment in the program, including a 10% reduction in hospital stays, according to a report by Modern Healthcare.
A recent survey of 350 employers by PriceWaterhouseCoopers indicated that just 15% of employees currently participate in wellness programs. Employers surveyed were most interested in programs that help employees lose weight, eat healthy, and reduce stress. They say their employees would be more likely to participate if offered incentives like premium reductions or gift cards.
Over at UnitedHealth Group, its OptumHealth subsidiary launched a project that compiles and analyses medical, pharmacy, behavioral health and laboratory data from claims, employer data and other sources. The goal is to use this information to identify the wellness needs of individual members based on health status. The company says its E-Synch Platform allows staff to take a personal approach to wellness, tailoring services to meet individual needs, and health goals.
Clinical lab managers and pathologists should recognize the market shift taking place as more employers and health plans jump on the wellness trend. This is a definite shift in clinical priorities and will require a different type of service support and test menu for laboratories and pathology groups. Patients in wellness programs need appropriate laboratory tests for screening different diseases and for predicting the patient’s likelihood to develop a chronic disease. This is a different emphasis for lab testing than, say, the 1980s, when most patients went to the doctor only after they felt sick.